First MTP Joint Fusion For Big Toe Arthrititis

What is a first MTP joint fusion?

This operation is designed to glue (fuse) the big toe joint. Once the fusion occurs, there will be no movement at the fused joints and thereby the pain is eliminated over this area. You will have one skin incision over the top of your big toe overlying the joint.The arthritic big toe joint is cleaned out by shaving off the worn out cartilage and the fusion is carried out with a small plate and screws.

Once fusion is successful, you will be able to wear most shoes, including a high heel if desired of about one and a half inches.

There are no limits to exercise activities after the fusion, including all sports and running.The screw typically stays in forever, unless you are able to feel it, when it can be removed if uncomfortable.

Type of procedure

This is a day case procedure and same day discharge is usual.

Type of anaesthesia

The operation will be undertaken under a general anaesthetic  supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

The surgery normally takes 45 minutes to an hour.

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.

This is a fairly routine procedure with risk of:

Infection

If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is extremely rare. Overall risk is 1%.

Pins & needles or patch of numbness:

Small nerve branches which supply sensation to the skin may be bruised or cut when the skin incision is made. This may cause pins and needles or a patch of numbness around the scar. This feeling generally resolves within a few weeks to a couple of months. Overall risk is 5%.

Nonunion:

The fusion is generally very successful.It is extremely rare for the joint to not fuse together. It may not fuse and remain painless in which case no intervention will be required. If there is ongoing pain, then a redo operation may be required rarely.Overall risk is 5%.

Clots – Deep vein thrombosis:

Extremely rare in foot and ankle surgery (<5%). There is no evidence to suggest that prophylaxis is required after surgery.

Recovery from surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot.A stiff sole shoe will be provided in which you can walk after surgery. The physiotherapists will make sure that you are safe on your feet before discharge. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol:

Day 1 – 7 

Ensure that you keep your foot elevated on pillows to help reduce swelling.

Foot wrapped in bulky bandage and surgical stiff sole  shoe

Allowed to walk in a stiff sole shoe.

Ice, elevate, take pain medication

Expect numbness in foot 12-24 hours then moderate pain

Bloody drainage through bandage expected.

Do not change bandage.

Do not remove surgical shoe even at night

Day 14

You will have a follow up visit in clinic.

You will have an Xray on arrival prior to seeing Mr Shariff

Your wound will be inspected. You will have absorbable sutures so they will not need to be removed.

6 weeks

Remove surgical shoe

Do not roll off on the big toe for one more month when walking.

A stiff soled shoe is important for one to two months

A regular shoe may then be worn as comfortable

No high heel is worn for two more months

12 weeks

You can expect swelling to last for about 4 months, but you will notice that it gradually starts to settle.

You will have started to wear normal foot wear by this time.

When are the post operative clinic visit schedule

2 weeks after surgery –  wound check and advice regarding basic hygiene

6 weeks after surgery – X-rays and advice regarding exercise

3 months after surgery – final follow up clinical exam and discharge

When can I begin to walk?

You are allowed to walk in a stiff sole surgical shoe on the day of surgery. However you must ensure that you use this shoe at all times for the first 6 weeks after your operation as this provides the necessary support while your bone heals.

0 – 6 weeks – stiff sole surgical shoe

6 – 12 weeks – shoe with a robust sole.

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is 4 to 6 weeks after surgery.

When can I get back to work?

Returning to work is very much dependent on the specific type of job and individual. As a rule of thumb –
Office based sedentary work – 4 weeks
Manual labour – 12 weeks

When can I get back to sport?

It depends on the kind of exercise, but as a general rule of thumb you can get back to sports like golf 3 to 4 months after surgery. For high intensity sport, this may take 6 months.