Dr. Anderson Explains How Cartiva Treats Toe Arthritis

Cartiva implants expand treatment options for patients with toe arthritis.


The pleasures of walking are extolled by writers and poets. But toe pain can make long strolls or even the prospect of a few steps a lot less enjoyable. Up to 40 percent of adults experience arthritic changes in their big toe joint. The symptoms that arise from these arthritic changes can severely affect at least 10 percent of the population. But a new medical advance has expanded treatment options for these patients. Foot and ankle surgeon Dr. Michael Anderson discusses Cartiva, a new implant treatment for big toe pain. This paradigm-shifting implant is helping select patients comfortably reclaim their favorite walking rituals.

Toe arthritis symptoms

“The metatarsophalangeal joint at the base of our big toe bends every time we take a step,” explains Dr. Anderson. “Hallux rigidus, or arthritis of this joint, is a common source of foot pain. This condition is accompanied by loss of protective cartilage in the joint. You may experience painful rubbing of the bones in the joint, growth of a bone spur, inflammation, and loss of motion.”

Toe arthritis treatment options

“The best treatment for big toe arthritis varies with the severity of the symptoms,” explains Dr. Anderson. “If you experience only an occasional twinge of toe pain, we can probably manage the condition conservatively and without surgery. If the pain is more constant or intense, we can offer surgical treatments to remove bone spurs and inflamed tissue. In severe cases, we may consider fusion of the joint. Medical advances have also given us an exciting new treatment option that people may not be aware of.”

Treating toe arthritis with synthetic cartilage

“There’s a new product called Cartiva that is really changing the treatment paradigm for big toe arthritis,” says Dr. Anderson. “Historically, one of the challenges in treating arthritis is that this disease damages the cartilage that cushions the joints. Cartilage can’t easily be regrown or repaired; once it is gone, it’s gone for good. That’s exactly what makes Cartiva so exciting. Cartiva is a synthetic cartilage developed to replace damaged cartilage in the toe joint. It was approved for use in the United States in July 2016. Despite the short time this implant has been available, I have considerable expertise with it because my fellowship mentor, Dr. Baumhauer, wrote the paper that lead to FDA approval of Cartiva. I have done dozens of Cartiva implants. It is a simple surgical procedure. For the right patient, this is a terrific treatment option.”

Cartiva implant advantages

Cartiva is a polyvinyl alcohol hydrogel implant. “It’s shaped and sized like a big jelly bean,” says Dr. Anderson. We implant it in the big toe joint to separate the arthritic bone surfaces and allow them to move on each other without rubbing. Treating toe arthritis with Cartiva offers several advantages.

  • Preserving toe motion without pain. Until Cartiva, fusion surgery was used to treat severe toe pain. The fusion resolved the pain, but after surgery the patient lost range of motion in the big toe. Unlike a fusion, Cativa implant surgery preserves toe motion after surgery.
  • Better second surgery outcomes compared to other surgical options. “No surgery has a 0 percent failure rate,” says Dr. Anderson. “Having a second surgery because the first one didn’t work is always a bummer. But if a Cartiva implant fails, we can correct it with an excellent outcome. This is not the case with previous attempts at joint replacement for the big toe. When a Cativa implant doesn’t work as well as we wanted it to, we do a fusion. We found that patients who have a fusion after a failed Cartiva implant have an outcome equal to that of patients who had a fusion as their first corrective surgery. Trying to repair a failed joint replacement is a very different story; second surgery outcomes after a fusion are significantly worse.”

Cartiva implants aren’t for everyone

“Research shows us that although Cartiva is a valuable new treatment option, it’s not the right solution for every toe arthritis patient,” says Dr. Anderson. There are two types of patients who don’t experience significant benefit from this treatment.

  • Patients with advanced toe arthritis. “If you have painful toe arthritis and very little toe mobility, Captiva can’t help you reclaim substantial range of motion in your big toe,” says Dr. Anderson. “Research tells us that Captiva patients can expect to gain about 6 degrees of motion from pre-op to post-op. This isn’t clinically significant. Patients who have already lost toe mobility are probably better served with a fusion surgery.”
  • Patients without pain through midrange of motion. “Some patients maintain a pain-free range of toe motion, but may have developed a bone spur that is causing pain,” Dr. Anderson explains. “If they don’t have pain with motion, they don’t stand to gain anything from Cartiva. These people do just fine with a bone spur removal surgery.”

Dr. Anderson points out that Cartiva implants haven’t replaced or eliminated the other procedures. Instead, this new option has augmented the treatment options available. “It’s my job to help my patients understand their options and to maintain the expertise to offer them the treatment that best addresses their condition. I am proud to be able to offer my depth of fellowship expertise in the Cartiva implant. But I work hard to make sure that I give my patient the right procedure, whether it is conservative treatment, Cartiva, or another surgical option.”

Summit Orthopedics offers personalized foot and ankle expertise

Our fellowship-trained foot and ankle physicians understand that your mobility depends on the health of your feet and ankles. If you have suffered an injury or are experiencing symptoms that make walking painful, our team of foot and ankle specialists can help with conservative treatment, seasoned surgical teams, and expert rehabilitation support. Summit Orthopedics specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely get you back on your feet and on your way.

Start your journey to optimal foot health. Find your foot and ankle expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MNPlymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

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  • Michael Anderson MD

    Michael Anderson, D.O.

    “Foot and ankle problems affect people from all walks of life. Whether your goal is to get back to competitive sports, live a more active life, resume work or enjoy time with family and friends, I’m here to help.”

    More about this expert

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