So, the biggest joint involved in the forefoot with arthritis is the big toe joint. And, for that, if we're speaking of surgical treatment, the number one gold standard procedure, over the years, has been a fusion. And so, you take the joint out, and you actually fuse the toe bones together. And, that, actually, has the best pain relief out of all of the options available.
There have been numerous joint replacements that have been tried over the years. There have been silicone. There have been different types of metal developed. But, there's a high stress that goes through this joint, and they have their own set of problems. The silicone can actually break down into particles, and your body will try to absorb these particles, and when it does, it causes an inflammatory reaction that can actually break down your bone. And so, you end up with a lot of bone loss from those types of implants. The metal implants have a tendency to loosen over time and can fail that way.
Recently, there have been some developments, as far as joint [arthroplasties] go. There's a new substance called Cartiva out, which is a polyvinyl alcohol. It's a big, fancy name for a substance that is a lot like your native cartilage. It's a [hydrogel]. It absorbs water and gets rid of water, much like your own cartilage does, so it provides good shock absorption. And, that implant has become the mainstay in my practice for those seeking a option to keep their joint moving, as opposed to doing a fusion or an arthrodesis procedure.
