Keeping you on your toes

New treatment: Cartiva is a synthetic cartilage substitute that is effective in alleviating pain while maintaining motion in patients with foot arthritis.

New treatment: Cartiva is a synthetic cartilage substitute that is effective in alleviating pain while maintaining motion in patients with foot arthritis.

Arthritis of the foot can be a debilitating condition. When pain is severe it can limit the distance a person is able to walk, make wearing footwear difficult or restrictive and affect their ability to participate in sporting activities.  

Foot arthritis occurs when there is loss of cartilage between the joint surfaces. This can occur due to trauma, inflammatory disease or can occur as part of ageing. 

Current available treatment consists of modified footwear, injections, pain medication or change of activity. Surgical treatment has previously consisted of the removal of painful osteophytes (dorsal bony bump) or fusion of the joint. Although effective, removal of the bump doesn’t address the cartilage loss, while fusion stiffens the joint.

Orthopaedic foot and ankle surgeon Dr Anthony Cadden, director of Seaview Clinic in Wollongong said, “A new option is now available in Australia for arthritis of the first toe. It is a synthetic cartilage product called Cartiva.

“My first experience with the product was in 2009 in Canada while working with one of the key researchers of the product. The implant is placed into the area of cartilage loss to create a spacer, effectively acting as replacement cartilage. 

“High level studies have shown effective relief of pain and maintenance of motion for over five years compared to a fusion, with studies soon to determine the result at 10 years.”

Surgery for foot arthritis may be indicated when the symptoms are no longer controlled with conservative management (footwear, inserts, medication, injections, activity modification). The decision to proceed is based on the severity of symptoms, the patient’s expectations and recovery time involved (time off work, not driving or not walking). 

The Cartiva procedure can be suitable for all adults as arthritis of the first toe can affect patients from the age of 30 onwards. The ideal patient for the procedure has painful arthritis with retained motion of the joint and minimal deformity.  However, the procedure may not be suitable for everyone.

Successful surgery with Cartiva can help foot arthritis by maintaining motion of the first toe joint, relieving the pain with activity and allow patients to wear a wider range of shoes compared with a fusion.

“A Cartiva procedure takes less than an hour of operating. It is performed as a day surgery procedure, and patients are able to walk in a post operative shoe straight away. It is also possible to perform the procedure on both feet at the same time,” Dr Cadden said.

“The shoes are often used over the first four weeks with motion to the toe starting after healing of the wound.  Surgery on the right foot may limit driving until a normal shoe can be put on the foot. Time off work will depend on the nature of the work, with office workers often returning after one to two weeks.  

“Some patients can expect to get some discomfort to the joint over a 12 month period, remembering the joint still has stiff ligaments that can take some time to stretch out.”

Dr Cadden said he has also made use of the product in patients with arthritis of the second toe. However, arthritis of joints to the midfoot is generally treated with fusion of the joint when surgery is performed. 

“Stability to the midfoot is more important than motion when painful arthritis is present, but most foot motion is still maintained,” Dr Cadden said.  “The only other joint that is suitable for a replacement procedure is the ankle joint. Total ankle replacement has been making improvements over the years, and can be an effective option to fusion of the ankle joint in the suitably selected patient.”

Dr Cadden has been performing ankle replacement in Australia for nine years and is the only surgeon performing this procedure on the South Coast and Southern Highlands region. 

He also offers minimally invasive or key hole foot surgery for bunions, hammer toes, corns and spurs.

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