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Meet Cartiva – the synthetic solution to the agony of toe arthritis

Consultant News

Arthritis in your toes can be a debilitating condition; at the very least, it is painful in a way that is likely to detract from your enjoyment of day-to-day activities, movement and exercise. 

Fortunately, Mr Nadeem Mushtaq – one of our leading orthopaedic consultants – employs an innovative surgical technique for dealing with the issue. 

Mr Nadeem Mushtaq is at the forefront of his specialism in all disorders of the foot and ankle, and complex trauma. We spoke to him about the causes and symptoms of toe arthritis, and the pioneering synthetic cartilage implant called Cartiva that he uses to treat osteoarthritis in big toe joints.

Orthopaedic consultant, Mr Nadeem Mushtaq.

What is the main cause of toe arthritis?

Arthritis is usually a result of the cartilage between joints starting to crack and erode, effectively removing the cushioning between bones in the joint. The pain from arthritis is a result of joint movement causing bone to rub on bone in the absence of cartilage.

To prevent the joint from moving and generating further symptoms, the human body reacts by laying down extra bone at the edges of the joint, which is what causes arthritic joints to become enlarged and stiff. 

Are there any early symptoms?

There are a range of symptoms associated with the condition, which can include the following:

  • Stiffness in the joint
  • Deformity
  • Enlargement of the joint
  • Pain around the toe
  • Redness and swelling around the joint
  • Difficulty wearing certain shoes and walking/exercising
  • Soft tissue irritation/inflammation

When should a patient seek medical advice?

If the swelling around your joint is persistent and doesn’t improve at all after a week of home treatment – or you’ve been experiencing pain that hasn’t improved after several weeks – you should consider seeking medical help.

Our expert team here at the Hospital of St John and St Elizabeth will quickly and accurately assess the affected area and provide effective solutions to any issues that we uncover. 

What is Cartiva – and how does work?

The Cartiva Synthetic Cartilage Implant (“SCI”) device is comprised of an organic hydrogel polymer made of polyvinyl alcohol and saline. Cartiva SCI has a high water content, and its elastic and compressive mechanical properties mean it behaves similarly to articular cartilage. 

The device is intended to replace focal areas of painful damaged cartilage, thereby reducing pain and maintaining range of motion in the big toe. The Cartiva SCI – a moulded, cylindrical implant – is placed into the big toe via press-fit implantation.

In this way, Cartiva replaces the damaged cartilage surface of the big toe, acting as a spacer to separate the two arthritic bones from grinding together. The implant is placed into the bone in your big toe. The CARTIVA Implant provides a new smooth, slippery surface in the joint and as a result, this implant contributes towards relieving the pain and stiffness in your big toe caused by the worn cartilage.

Who would be most suitable for this treatment?

The Cartiva Synthetic Cartilage Implant is intended for use in the treatment of patients with painful degenerative or post-traumatic arthritis (hallux limitus or hallux rigidus) in the big toe joint – with or without the presence of mild hallux valgus.

What can a patient expect from a consultation?

Coming to the London Foot and Ankle Specialists at the Hospital of St John and St Elizabeth for your consultation will involve looking at your comprehensive medical history to discuss your foot problem and any related issues. 

You should come prepared to describe how the pain and deformity is affecting your daily functions, your walking, your sleep and any sports that you might play. It may be helpful to make some notes before the consultation to avoid forgetting anything you want to bring up.

Next, our consultant will examine your foot, and they may need to examine other parts of your body as well – for example your spine, hips and legs – if there are associated problems. We then usually require an X-ray, after which the consultant will explain the findings to you.

Finally, if no other investigations are required, your consultant will discuss with you the types of management available (non-operative or operative) for your condition, and together you will agree on a plan for further management.

How long is the recovery period and what is the aftercare?

Cartiva patients can expect to experience a clinically meaningful reduction in pain two weeks following surgery, with the maximum amount of pain reduction starting at six months and beyond.

No plaster cast is required, but a heavy dressing and post-op shoe are applied. We then encourage patients to undertake range of motion and weight-bearing exercises as soon as possible. 

A follow-up appointment will be made for two weeks post-surgery when the dressings are removed and the wound is inspected, at which point you can start on more strenuous exercises and physiotherapy. The post-op shoe can be changed to loose-fitting trainers at this stage.

What are the benefits of a patient visiting London Foot and Ankle Specialists?

The Foot and Ankle Team at The Hospital of St John & Elizabeth offers the very best of care and attention. Our Foot and Ankle Consultant team are world class, helping to treat a variety of conditions and address underlying problems within a state-of-the-art unit.


To contact Mr Nadeem Mushtaq or book an appointment call 0207 806 4044 or email us at footandanklespecialists@hje.org.uk