Big Toe (1st MTPJ) Fusion
The joint at the base of the big toe (1st metatarsophalangeal, or MTP, joint) is commonly affected by arthritis. Fusion (arthrodesis) of the joint involves getting the two bones to surgically knit together, and is the most reliable and predictable method of relieving pain and improving function. After 1st MTP joint fusion, most patients have little or no discomfort and are able to live a very active life.
An incision is made over the top of the 1st MTP joint, and the tendon that extends the big toe (EHL) is protected. Once the joint is entered, any remaining cartilage is cleared away. Special tools called reciprocal reamers are used to prepare the joint surfaces for a perfect fit.
Once prepared, the two bones are positioned together and a plate and screws are used to compress and secure the joint. Once the hardware has been inserted and checked with xrays, the joint capsule and skin are then closed with stitches, and a local anaesthetic block is given for post-operative pain relief.
This procedure is usually done as a day procedure, and patients can typically mobilise with weight bearing on the heel in a stiff-soled surgical shoe soon after surgery. Some patients may need a stick, crutches, or a frame for a few days after surgery. After discharge, the dressings and bandages must all stay intact and dry until review 2 weeks after surgery.
A minimum of 2 weeks off work is required to allow for rest and elevation to control swelling and pain. At 2 weeks after surgery, the wound is checked and any sutures are removed (most of the time these will be under the skin).
The surgical shoe must be worn for 6 weeks after surgery in order to protect the fusion site. At 6 weeks post-op, xrays are done to check on bone healing and generally patients transition to wearing normal supportive shoes.
The joint generally takes 8 to 12 weeks to fuse in healthy patients. Most activities can be recommenced from 12 weeks post-op, and full recovery is generally 3 to 6 months. Every patient’s recovery is individual, of course, and depends on many factors.