Cartiva Implant for Hallux Limitus

Updated 9/18/2018
Dr. Baravarian on ABC News discussing Cartiva, the new treatment which offers joint flexibility for those suffering from toe arthritis.

Cartiva: A Fusion Free Solution to Big Toe Arthritis

Great toe arthritis, also known as hallux limitus and hallux rigidus, is one of the most common conditions we treat at UFAI, which is why we are pleased to bring you Cartiva.


Cartiva is a new surgical implant that our world-class surgeons have adopted to successfully treat joint immobility and restore foot function and quality of life to our patients.


Our surgeons have decades of combined experience treating hallux rigidus and have successfully performed more Cartiva implant procedures than any other clinic in Southern California.







Diagnosing Osteoarthritis of the Big Toe

Cativa Implant, Podiatry Today
UFAI's Dr. Baravarian discussing hallux limitus and the Cartiva implant in Podiatry Today.

Osteoarthritis of the big toe joint refers to the pain and stiffness caused by damage to the cartilage. The stiffness leads to frequent jamming of the toe, with bone spurs eventually forming upon the big toe joint.


Great toe arthritis, is diagnosed on a scale of severity ranging from level 0 to level 4:


  • Level 0: Normal joint, some damage to the cartilage
  • Level 1: Mild bone spur formation, but with no narrowing of the joint space
  • Level 2: Moderate bone spur formation, some narrowing of the joint
  • Level 3: Severe bone spur formation, narrowing of the joint, some obliteration of the joint
  • Level 4: Severe bone spur formation, complete joint obliteration


This scale is helpful to doctors when crafting a treatment plan. While levels 0 and 1 can usually be treated non-surgically with orthotics and shoe modification, level 4 typically requires a joint fusion – removing the joint altogether and fusing the bones.


Difficulty in Determining Course of Treatment

The difficulty in treatment usually arises with levels 2 and 3, when foot function could be restored, but not without some surgical treatment. In these cases, surgeons need to make treatment decisions at the time of surgery, and on a case-by-case basis.


For example, the surgeon may remove the bone spur, but find that the joint remains stiff and inflexible. In that case, an osteotomy may be performed by removing a fragment of the bone to restore some mobility. However, even this can be an insufficient treatment if there is substantial damage to the surface of the bone at the joint. Until now, there have been no surgical implants on the market that have adequately addressed the problem.


How Cartiva Works

Cartiva Implant for big toe arthritis, University Foot and Ankle Institue

Fortunately, the FDA has recently approved Cartiva, a gel-like implant that has worked wonders for arthritis patients across Europe and Canada, and now, here at UFAI as well. Cartiva is a synthetic cartilage implant designed to act as a replacement for arthritic joint tissue. The gel material mimics the quality and density of bone, eliminating the problematic side effects of metal implants, which can damage or become absorbed by the bone over time.


After the bone spur is removed from the big toe joint, a small (1cm) hole is drilled into the head of the first metatarsal – the longer bone connecting the mid-foot to the big toe joint. Next, the Cartiva gel is injected into the hole, which expands to fill the space and overflows just a couple millimeters over the edges of the metatarsal head surface, like a muffin in a pan. This acts as a cap on the joint, decreasing the bone-on-bone contact responsible for arthritic pain.


Benefits of the Cartiva Implant

The Cartiva implant is very much similar to the strength of bone and cartilage, which results in limited to no bone absorption or damage. Additionally, there is no breakdown of the bone overtime so there is less chance of cyst formation.


Should the Cartiva implant wear out it can be replaced. And because the bone anatomy is kept intact, it is likely that the implant can be changed out with minimal downtime or risk.


The Cartiva implant procedure can be combined with bone spur removal procedures as well as bone realignment procedures, which is not often possible with other implant procedures. This allows the surgeon to reposition the bone and remove the spurs that limit motion for better results.


Should there be a need for future revision surgery to fusion of the joint, the anatomy is kept intact with the Cartiva implant system so there is no need for bone graft, and the surgical procedure is far less complicated than common revision implant surgeries today.


Cartiva Implant vs. Other Hallux Limitus Surgical Options

Unlike metal implants, Cartiva does not cut into or damage the bone or joint surface over time. Metallic implants are stronger than the bone and require significant amounts of bone resection, which can cause problems in the future for revision surgery. And because the metal is stronger than bone, the metal impacts the area resulting in bone destruction and movement of the metal implant into an unwanted position. This may result in pain and failure of the procedure.


The Cartiva implant is also durable, able to withstand loads similar to natural cartilage, and bio-stable, meaning it will not degrade in the body. Silicone implants, often used in hand arthritis, can’t hold up to the stresses of the great toe and cause cyst formation and bone break down as the silicone begins to degrade.


Fusion, currently the mainstay of treatments, can cause stiffness of the joint and limitation of shoe options. Although fusion is a great option, in certain cases, motion of the great toe is a preference and may be the best option for certain patients


If Cartiva does not completely relieve a patient’s symptoms, the gel-like substance allows for an easy conversion to a fusion procedure. For these reasons, Cartiva is a great option for treating moderate level hallux limitus.


Cartiva Yelp Patient Review, In Her Own Words

The following five star Yelp review was posted by University Foot and Ankle patient, Giovonna.

5 Star Yelp review, University Foot and Ankle Institute

About 13 weeks ago (going on 14 weeks this Friday) Dr. Baravarian gave me a Cartiva implant for a severely arthritic big toe. It was an outpatient procedure. I wore a boot for the first 2-3 weeks then switched to a comfortable sandal. The procedure was successful in that I can now truly state that my foot feels much better in an enclosed shoe (a tennis shoe). Today was the first day in an enclosed shoe. The pain is gone. There is some discomfort but I am now confident it will heal completely.


Anyone receiving this procedure must be made aware that you need to be patient with the healing process as everyone is different in how quickly they heal. Remember that your feet carry all of the weight of your body. Healing takes time. Dr. Bavarian and his staff have been great throughout this entire journey. With frequent follow-up appointments, he is very diligent about ensuring that everything is going well post-op. I would recommend Dr. Baravarian and this procedure. I just wanted to share my experience should anyone reading this is considering this procedure.


Click here to see Giovanna's review on



Recovery From the Cartiva Procedure

Recovery from the Cartiva implant procedure is quite simple. Patients are kept in a boot for 2-3 weeks to allow the soft tissue and incision to heal. Subsequently, they are sent to physical therapy or given home exercises and placed in a comfortable tennis shoe. Patients can to normal activity and regular shoes after 5-6 weeks at which point swelling has decreased and range of motion is improved. This is a significant improvement to recovery times with metal implants.


Cartiva has been shown to reduce pain, and improve range of motion and foot function. Following surgery, patients should practice range-of-motion exercises early on in the healing process to prevent scarring.


By offering a full spectrum of work up, conservative, surgical and recovery options, we are truly taking care of you in a state of the art manner without the need to go from place to place. We treat patients like family while providing world-class care.




Frequently Asked Questions about Hallux Limitus and Cartiva


Q. I have heard that arthroplasties of the big toe don't last long and that the Cartiva implant is a great option for hallux rigidus. Can you tell me how long the Cartiva implants last?

A. The Cartiva Implant has the potential to last for 20 years. It is too new to know for sure, but conversion to fusion is very easy so that is always an option, if needed, as time goes by.


Q. I am a hiker (and former runner). I developed hallux rigidus 8 years ago in both big toes and had cheilectomy surgery. I got some relief from the surgeries, but am now back to pre-surgical pain. Are there any new procedures that can help with range of motion and pain, other than fusing the joint?

A. Yes, there is a new gel implant called Cartiva and is part of our Gel-Toe Protocol for Toe Arthritis. The Cartiva implant has been shown to reduce pain, improve range of motion and quality of life to our patients. It is a great option for both joints that have been previously operated on and those that have not. University Foot and Ankle Institute was a leader in the development of this new implant. You can view us discussing this procedure on ABC news by clicking here.


Have a Hallux Limitus question we should add to our FAQ's? Please let us know by clicking here.







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