Knee Cartilage
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TOAT
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
Big toe arthritis
and why preserving motion matters
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.
- Osteoplasty reshapes the first MTP joint to restore normal contour.
- Cartilage augmentation is then applied to the prepared surface to restore the joint lining.
- Joint motion is preserved rather than sacrificed, which matters for walking, push-off and balance.
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.
The procedure
and what to expect
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.
- Stiff-soled post-operative shoe for four to six weeks.
- Early gentle motion to prevent stiffness, supervised by physiotherapy.
- Return to normal footwear by six to eight weeks, full activity by three to four months.
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
Most patients have more treatment options than they have been told
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.
Preserve
Protect what you have. Slow degeneration and manage symptoms.
Repair
Fix specific damage. Torn tissue, unstable joints, structural problems.
Regenerate
Rebuild lost tissue. Biological treatments that stimulate new growth.
Replace
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.
Frequently Asked Questions
What does TOAT stand for?
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.
Who is TOAT considered for?
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.
How does TOAT differ from cheilectomy or fusion?
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.
What is the recovery after TOAT?
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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