TOAT (Toe Osteoplasty with Augmented Transplantation) is the big-toe counterpart to the KOAT technique. It is designed for hallux rigidus and other forms of big toe arthritis where both the cartilage of the first MTP joint and the underlying bone need attention. By reshaping the bone first and augmenting the surface with cartilage, TOAT creates a stable, motion-preserving big toe joint. Offered at London Cartilage Clinic as a joint-preserving alternative to fusion or replacement for selected patients.
Reviewed byProf Paul Lee MBBch, FRCS (Tr & Orth), PhDLast reviewed 1 May 2026
Hallux rigidus and big toe arthritis are very common conditions that limit walking, running and even comfortable shoe wear. The standard surgical answers are cheilectomy, fusion or replacement, each of which trades motion for relief in different ways.
TOAT is a joint-preserving alternative for patients who would otherwise be heading for fusion, where the disease stage and joint anatomy are still amenable.
TOAT is performed as a single-stage operation. The bone of the first MTP joint is reshaped first, then cartilage tissue is augmented onto the prepared surface to create a smooth, motion-preserving joint.
TOAT is offered to selected patients with appropriate disease stage and joint anatomy. Your surgeon will determine whether this approach is right for you based on imaging, examination and your activity goals.
You may have more options than you think
At London Cartilage Clinic we follow a structured clinical framework across four areas of treatment. Before recommending a single procedure, we assess which combination of approaches gives you the best outcome.
Protect what you have. Slow degeneration and manage symptoms.
Fix specific damage. Torn tissue, unstable joints, structural problems.
Rebuild lost tissue. Biological treatments that stimulate new growth.
When other options are exhausted. Joint replacement as a last resort.
Explore the full range of treatments available for your joint. Each hub page shows every option we offer, organised by clinical approach.
TOAT refers to Toe Osteoplasty with Augmented Transplantation. It is the big-toe equivalent of the KOAT technique used in the knee, combining bone reshaping with cartilage augmentation in a single operation, applied at the first metatarsophalangeal (MTP) joint.
TOAT is considered for hallux rigidus and other forms of big toe arthritis where the cartilage of the first metatarsophalangeal joint is damaged and the underlying bone has spurred or collapsed. It is a joint-preserving alternative to first MTP fusion or replacement, suited to patients who want to retain joint motion.
Cheilectomy removes bone spurs but does not address the cartilage surface. Fusion eliminates the joint and the motion that goes with it. TOAT addresses both the bone contour and the cartilage layer in a single procedure, with the goal of preserving big-toe motion. The right choice depends on the stage of disease and your activity demands.
Protected weight-bearing in a stiff-soled shoe for four to six weeks while the bone remodels and the cartilage integrates, with early gentle motion to prevent stiffness. Return to normal footwear from six to eight weeks, with full activity from three to four months depending on progress.
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