Patient guide · Foot and ankle · 6 min read

If you've reached the point of discussing surgery for a painful big toe, you've probably already tried a lot. Stiffer shoes, insoles, painkillers, rest. Now someone has mentioned an operation, and your head is full of questions you're not sure how to ask.

That's completely normal. Surgery is a big decision, and the best outcomes tend to come from patients who go into the consultation prepared. This checklist gives you ten questions worth asking, along with some context on what you might hear, including a new treatment for big toe arthritis that uses a very small incision.

First, a quick reminder of what's going on

Big toe arthritis, or hallux rigidus, is wear and tear of the joint at the base of the big toe. The cartilage thins, the bones can rub, and extra bone can form, causing a painful lump and stiffness. According to Mr Pavel Akimau's website, it affects around 8% of people and usually develops slowly.

Question 1: Is arthritis definitely the diagnosis?

It sounds obvious, but confirm it. A careful examination and imaging, usually an X-ray, should show how advanced the joint changes are. The answer shapes every option that follows.

Question 2: Have I really tried everything else?

A good surgeon will ask what you've already done and may suggest options you haven't tried, such as stiffer-soled or rocker shoes, specialist insoles and changes to your activity. Surgery should usually follow a fair trial of these, not replace it.

Question 3: What are my surgical options?

In broad terms there are two. Joint-sparing surgery removes the bony overgrowth and keeps the joint, so movement can be preserved. Fusion removes the damaged joint surfaces and holds the bones together with metal implants, creating a stable, pain-free toe that no longer bends. Ask why one might suit you better than the other.

Question 4: Can this be done through a small incision?

This is where newer techniques come in. In suitable patients, a joint-sparing procedure called a cheilectomy can be performed through a tiny cut in the skin, aiming for minimal tissue injury and a faster recovery. According to Mr Akimau, he is one of the few surgeons performing this through such a small incision. If you're researching a new treatment for big toe arthritis, ask whether you're a suitable candidate and what the realistic benefits and limits are. Not everyone is, and an honest answer is a good sign.

Question 5: What are the risks?

Every operation carries some, from infection and swelling to stiffness or the need for further treatment. A good surgeon will explain them plainly and put them in proportion for your age, health and expectations. Don't be shy about asking what could go wrong.

Question 6: What will recovery involve?

Ask what you'll be able to do and when: walking, driving, returning to work, getting back to exercise. Recovery varies between procedures and between people, so avoid comparing yourself with friends' experiences and ask for a realistic picture for your case.

Question 7: How much movement will I keep?

This matters especially if you're active. Joint-sparing surgery aims to preserve movement. Fusion deliberately doesn't. Ask how each option fits the activities you care about, such as walking, running, dancing or kneeling.

Question 8: How experienced are you with this procedure?

It's a fair question, and a good surgeon will welcome it. Ask how often they perform the operation and what techniques they use. Mr Akimau is a Consultant Orthopaedic Surgeon with expertise across the full range of elective and traumatic foot and ankle conditions, and he regularly performs both fusion and minimally invasive joint-sparing surgery, as well as open surgery when it's the better choice.

Question 9: What if I decide to wait?

Waiting is a legitimate choice, as long as you understand what to watch for. Ask which changes would mean it's time to review, such as pain at night, a growing lump or reduced walking distance.

Question 10: What should I do to prepare?

Practical preparation helps. Ask about shoes, time off work, help at home and whether you'll need support with transport. Arrange these in advance so you can focus on getting better.

Making the most of the appointment

• Write your questions down before you go.
• Bring a list of medications and any previous scans.
• Take a friend or relative if it helps you remember the discussion.
• Ask for the plan in writing, or take notes.
• Don't feel pressured to decide on the day.

Frequently asked questions

Final thoughts

A good consultation feels like a conversation, not a sales pitch. Go in with your questions, listen to the answers and take your time. If you'd like to find out whether a new treatment for big toe arthritis could suit you, you can book a consultation with Mr Akimau by calling 07934 539252 or 01782 432227, or emailing help@pavelakimau.com.

This article is for general information and isn't a substitute for personal medical advice.