How Successful Is Foot Surgery for Arthritis?

Most people who undergo foot surgery for arthritis experience meaningful pain relief, though how much improvement you can expect varies by which joint is involved and which procedure is performed. Satisfaction rates across the most common operations range from about 70% to over 90%, and functional scores roughly double in many studies. The picture gets more complicated when you look at the details: a bone-spur cleanup on a big toe is a very different operation from a total ankle replacement, and the success profiles of these procedures diverge in important ways.

Big Toe Arthritis and Joint-Sparing Surgery

Arthritis at the base of the big toe, often called hallux rigidus, is one of the most common reasons people seek foot surgery. The first-line surgical option for mild to moderate cases is cheilectomy, a procedure that shaves away bone spurs and frees up joint motion. In a long-term follow-up of 169 feet, about 70% remained pain-free at last check-in, and roughly 85% had pain relief in the period right after surgery. About 69% of patients said they were satisfied or very satisfied, and three-quarters said they would have the procedure again under the same circumstances.¹ When pain did come back, it tended to return within the first two years. Only about 5% needed a second procedure.

Newer minimally invasive versions of cheilectomy appear to push satisfaction even higher. A systematic review of patient-reported outcomes after minimally invasive techniques found that over 95% of patients were satisfied or very satisfied, and about 91% would recommend the procedure.² These numbers are encouraging, though they come from smaller studies with shorter follow-up than the traditional cheilectomy data.

Big Toe Fusion and Implant Options

When arthritis in the big toe is too advanced for a bone-spur cleanup, surgeons typically recommend either fusing the joint (arthrodesis) or replacing part of it with an implant. Fusion has long been considered the gold standard for severe cases. It eliminates pain by locking the joint in place, which means you lose the ability to bend the toe but gain a stable, pain-free push-off for walking. A pilot randomized trial comparing two types of screws for big toe fusion found that the overall bone-healing rate was about 90%, with functional scores averaging around 89 to 90 out of 100 at two years regardless of the screw material used.³

Implant hemiarthroplasty, which replaces the damaged cartilage surface with a synthetic material, is a newer alternative that preserves some joint motion. One study found that success rates between implant hemiarthroplasty and fusion were similar when stratified by disease severity, gender, age, body mass index, and several other patient factors.⁴ A separate midterm study of synthetic cartilage implants in 70 patients found that only three needed conversion to fusion due to ongoing pain at the five-year mark.⁵

One important practical consideration: if a first surgery on the big toe fails and you need a salvage fusion later, the reoperation and complication rates climb. A national database study found that salvage fusion carried higher rates of reoperation compared to primary fusion, along with roughly double the risk of nonunion and more than double the rate of hardware removal.⁶ That does not mean you should jump straight to fusion, but it is worth understanding that a second bite at the apple is harder than the first.

Midfoot Arthrodesis

Arthritis in the midfoot, the cluster of small joints across the arch, is less talked about than big toe or ankle arthritis but can be debilitating. Midfoot fusion is the primary surgical treatment, and the results are generally strong. In a study of 104 feet, bone union was achieved in 92% of cases, pain scores dropped from an average of 7 out of 10 before surgery to 2 out of 10 afterward, and 90% of patients were satisfied with their outcome.⁷ Functional scores more than doubled, going from a preoperative average of 32 to a postoperative average of 79 on a standard 100-point scale.

A smaller case series looking at a newer fixation method with nitinol compression staples reported union in about 93% of midfoot procedures, with a median time to healing of roughly two months.⁸ The numbers are broadly in line with older fixation methods, which suggests that the underlying biology of midfoot fusion is fairly reliable across hardware choices. One thing to be aware of, though, is that fusing joints in one part of the foot can occasionally lead to increased stress and arthritis in neighboring joints. An ongoing review of patients who had fusion at the first tarsometatarsal joint found that about 7% had developed arthritis in an adjacent joint at their last imaging follow-up.⁹

Hindfoot and Subtalar Fusion

The subtalar joint, which sits just below the ankle and controls side-to-side motion of the foot, is a common site for arthritis after fractures or chronic instability. Subtalar fusion reliably reduces pain: a systematic review found that average pain scores dropped from 6 out of 10 before surgery to about 1.6 out of 10 afterward.¹⁰ A multicenter retrospective study confirmed substantial functional gains, with standard outcome scores nearly doubling from the preoperative baseline.¹¹

It is worth noting that hindfoot fusion, while effective for pain, does not restore your foot to normal. A study of patients with subtalar fusion for post-traumatic arthritis found that quality of life remained lower than the general population, even though pain improved substantially. Still, 90% said they would recommend the procedure to someone else in the same situation.¹² That gap between “better” and “normal” is an important expectation to set before going in.

Total Ankle Replacement Versus Ankle Fusion

Ankle arthritis presents the highest-stakes decision in foot surgery because you are choosing between two fundamentally different philosophies: replacing the joint with a prosthesis to preserve motion, or fusing it solid to eliminate pain at the cost of flexibility. Both work, but the tradeoffs shift depending on how far out you look.

In the short term, total ankle replacement appears to have an edge. A meta-analysis found that replacement patients had better clinical scores and lower revision and complication rates in the first few years.¹³ At medium-term follow-up, replacement still showed higher patient satisfaction, but complication and revision rates began to climb above those of fusion. By the long term, there was no significant difference in clinical scores or satisfaction between the two, and replacement carried substantially higher revision and complication rates.

A large randomized trial in the UK (the TARVA trial) comparing the two operations at one year found no statistically significant overall difference in walking and standing function, though a post-hoc analysis of patients who received a fixed-bearing implant design did show a meaningful advantage for replacement. Wound-healing issues and nerve injuries were more common in the replacement group, while the fusion group had a 12% nonunion rate on X-ray, though only about 7% of those patients had symptoms from it.¹⁴

Long-term national data from England spanning 25 years and over 41,000 patients paints a clearer durability picture. The fusion revision rate was dramatically lower at every time point: about 2% at five years compared to 6% for replacement, and roughly 3% at 20 years compared to nearly 14% for replacement. There was no significant difference in the risk of developing arthritis in neighboring joints, a concern that has historically been used to argue in favor of replacement.¹⁵

A systematic review of long-term outcomes after ankle replacement found that while patients generally reported improved function at ten or more years out, survivorship of the implant varied widely, from 66% to about 94% depending on the study and the implant design.¹⁶ One Swedish registry study of 780 implants reported a 10-year survival rate of 69%, with women under 60 who had osteoarthritis at higher risk of needing revision.¹⁷

The choice between the two is genuinely patient-specific. If you are younger and active and want to keep ankle motion for sports or uneven terrain, replacement may be worth the trade of higher long-term revision risk. If you prioritize durability and want the procedure you are least likely to revisit surgically, fusion has a much stronger track record. Neither option is wrong, but going in with realistic expectations about the timeline of each is essential.

Does the Type of Arthritis Matter?

Most foot arthritis is osteoarthritis, the wear-and-tear kind. But inflammatory forms like rheumatoid arthritis also commonly affect the foot and ankle. The good news is that outcomes appear broadly similar between the two when it comes to ankle replacement. A propensity-matched study found no significant differences in clinical outcome scores between rheumatoid and osteoarthritis patients at a mean follow-up of seven years. Radiographic measures of implant alignment and loosening were also comparable.¹⁸ Rheumatoid patients did have a few specific complications that the osteoarthritis group did not: three cases of fracture around the implant and two wound-healing problems. If you have rheumatoid arthritis and are considering ankle replacement, these are manageable risks but worth discussing with your surgeon, especially if you are on immunosuppressive medications that can slow wound healing.

Risk Factors That Undermine Success

Not every patient heals equally. Smoking is the single most studied risk factor in foot and ankle surgery, and the data is stark. A systematic review found that smokers had a wound infection rate of about 15%, compared to lower rates in non-smokers, along with nonunion rates roughly double those of non-smokers.¹⁹ The issue is not just traditional cigarettes. Nicotine from non-tobacco sources also impairs bone healing. A study of midfoot fusion patients found that non-tobacco nicotine dependence was linked to increased rates of pseudoarthrosis (incomplete fusion) and mechanical implant failure at two years.²⁰ If you use nicotine in any form and are planning a fusion procedure, quitting well in advance of surgery is one of the most impactful things you can do to improve your odds.

Diabetes, obesity, and prior surgery at the same site also affect outcomes, though their influence is harder to isolate in the data. In one single-institution cohort comparing ankle replacement to fusion, the fusion group had a much higher prevalence of diabetes, which may have contributed to that group’s higher nonunion rate.¹⁵ These comorbidities do not disqualify you from surgery, but they do mean your surgeon should be accounting for them in planning.

When Surgery Fails and What Happens Next

Even with good surgical technique and healthy patients, a percentage of foot arthritis operations do not deliver lasting results. The question then becomes whether a revision can salvage the situation. For ankle replacement specifically, a systematic review found that about 27% of patients who had a revision replacement needed yet another surgical intervention, and about 14% of revision replacements ultimately failed. Conversion from a failed replacement to a fusion fared somewhat better, with about 8% of those conversions failing.²¹

A more recent comparative analysis of revision ankle replacements found a failure rate of about 14% among 87 patients. When a revision replacement failed, surgeons chose a variety of salvage approaches: some patients got a second revision replacement, some were converted to fusion, and in one case amputation was required. Notably, half of the failed revisions were managed with another replacement rather than abandoning the implant entirely.²² A separate cohort analysis found five-year survival after revision was slightly higher for repeat replacement (97%) versus conversion to fusion (93%), though durability dropped off after about seven years.²³

The practical takeaway is that revision surgery is possible and often effective, but it carries higher risk and lower reliability than getting the primary operation right the first time. This is another reason surgeons emphasize careful patient selection, adequate preoperative planning, and optimizing your health before going to the operating room.

Is Foot Arthritis Surgery Cost-Effective?

Surgery is expensive, and it is reasonable to wonder whether the investment pays off in quality-of-life terms. Health economists use a metric called cost per quality-adjusted life year (QALY) to answer this. For big toe fusion, a UK analysis using national registry data found a lifetime cost of about £4,700 and a QALY gain of over 3.3, yielding a cost-effectiveness ratio that was far below the thresholds typically used to justify healthcare spending. Under optimistic assumptions, the procedure actually became cost-saving by year 18.²⁴

For ankle replacement versus ankle fusion, an economic model found that replacement cost about $20,200 more than fusion but produced an estimated 1.7 additional quality-adjusted life years, making it cost-effective by standard benchmarks despite the higher upfront price tag.²⁵ These models depend heavily on assumptions about implant durability and revision rates, so the numbers should be taken as guides rather than guarantees. But the broad message is that foot arthritis surgery, when appropriately indicated, represents reasonable value for the healthcare dollar.

Measuring Success and What the Numbers Actually Mean

One challenge in interpreting surgical success rates is that researchers use dozens of different outcome tools. A systematic review evaluating measurement instruments across foot and ankle surgery identified 23 different patient-reported outcome measures in use.²⁶ Some of these scales grade function on a 100-point scale, others ask about pain on a 10-point scale, and others measure broader quality of life. A study might report a mean postoperative score of 79 out of 100, which sounds good, but without knowing the minimum change that patients actually notice and care about, the number is hard to interpret.

Researchers have started establishing thresholds for what counts as a meaningful improvement from the patient’s perspective. For ankle osteoarthritis surgery, one study estimated that patients need to see a gain of roughly 9 to 14 points on specific subscales to perceive a real difference in their daily life.²⁷ Another study validated that commonly used PROMIS scores can reliably distinguish between patients who feel their surgery was a success and those who do not.²⁸ When you look at the studies cited throughout this article, most foot arthritis operations clear these thresholds comfortably for the average patient, which is reassuring.

Keep in mind, though, that averages can mask individual variation. Not everyone who achieves a “successful” score on a questionnaire feels the same way. A study of nerve treatment for midfoot arthritis pain found that while pain interference scores improved on average, only about 47% of patients crossed the threshold for a clinically meaningful reduction in pain, and only about 22% saw a meaningful improvement in physical function.²⁹ That does not mean most patients were unhappy, but it does highlight that group averages and individual experience can diverge.