Great toe MTPj fusion


What is a 1st Metatarsal phalyngeal joint (MTPj) fusion of the Great toe?

1st MTPj fusion is performed due to arthritis of the ball joint of the great toe (Hallux Rigidis) which has become chronically painful and interferes with everyday activities. Arthritis occurs when the articular cartilage wears out and the underlying bone becomes exposed and grinds on the bone on the other side of the joint. This causing pain and swelling. Spur formation is also common, causing prominence which can make wearing shoes uncomfortable.

The standard treatment for arthritis of this joint is fusing (stiffening) the joint as it is a reliable way to stop the pain.

What are the risks of 1st MTP joint fusion?

The 1st MTPj fusion is a quick and effective operation. The majority of surgeries go very smoothly without any major complications.

There may be a degree of pain for approximately 2 weeks. Persisting pain is very uncommon. It is common for patients to experience swelling around the fused joint, which can take several weeks to settle. Occasionally patients experience some transient numbness around the incision

Serious complications such as infection and blood clots are very rare.

Persisting stiffness is the consequence of the surgery but is adapted to very well as the pain is gone. People generally walk without a limp and some can jog. Wearing a heel greater than 1 ½ cm is generally too uncomfortable. Physiotherapy following surgery is not often required

Non- union or failure to fuse the joint is very rare but a possible complication. It occurs more frequently in smokers and diabetics. This is a possible cause of persisting pain beyond 12 weeks post surgery and if there is a persisting non-union further surgery may be required.

How long does 1st MTPj fusion surgery take?

An uncomplicated stabilisation takes about 60 minutes to perform.

Generally it is performed as Day Stay Surgery and you may go home the same day as your procedure.

You will need someone to drive you home, and a responsible adult to be with you overnight as you may still be sleepy and require oral pain medications.

What Happens on the day of surgery?

DO NOT EAT OR DRINK from midnight, unless otherwise instructed.

Dr Schluter will meet with you, answer any further questions, check the consent form and mark the operative leg. You will also meet the anaesthetist (specialist doctor) who will be providing the anaesthetic. In most cases the procedure is done under a general anaesthetic. An IV line (drip) will be inserted and you may be given some

What should I expect immediately after the operation?

After the operation you will go to the recovery room where nursing staff will monitor you until you are awake. You are likely to have a cast over your forefoot made of plaster of Paris to keep the forefoot immobilised. You can put weight on the heel but do not put any pressure through the great toe. You will be supplied with crutches for balance.

As you wake up you will notice the foot is completely numb due to the local anaesthetic that is used for pain relief (ankle block). This will wear off after about 8-12 hours when the incision site will start becoming uncomfortable and this is when you start taking the prescribed pain relief. Once you are alert, you will be encouraged to get up and mobilise slowly. Once you can mobilise safely you will be ready for discharged home.

What follow up should I expect?

Dr Schluter will review you at a follow up appointment 1- 2 weeks after your surgery. He will review your wounds and remove any sutures that are not dissolvable. You will be able to discuss the findings of procedure, update work certificates if required and get a prognosis (estimate) of the time to recovery.

How do I look after my ankle when I get home?

For the first 14 days it is very important to elevate the foot when you are resting. Rest is important to allow the swelling and inflammation to settle. Take the pain relief medication regularly as prescribed

Because it is immobilised in the cast the foot should not be too painful. You cannot get the cast wet so when showering, you will need to cover it with a plastic bag and tape it securely. There may be some bruising and swelling and occasionally some bleeding visible though the cast. This will occur in the first 3 days and stops with elevation and will not require a cast change. Generally you will have the cast removed, dressings changed, wound checked, strapped with a Coban bandage and fitted into a Darco surgical sandal at the first clinic appointment. You continue to weightbear through the heel in the Darco sandal for 6 weeks after surgery. You can shower out of the sandal but cover the bandage with a plastic bag. The Coban bandage can be removed at 4 weeks post surgery and the wound can be left uncovered from in the shower if it has healed well.

With the exception of showering, leave the Darco sandal on at all times (including in bed at night), until instructed to take it off at 6 weeks post op. An Xray is taken at this stage to check on the healing of the fusion

You cannot drive with a Darco sandal on the right foot. You can drive with a Darco sandal on the left leg if you have an automatic car after 3-4 weeks post surgery, but it is not recommended for long trips. Avoid flying for the first 6 weeks if possible because of swelling and risks of blood clots.

My foot is still swollen, is this normal?

It is quite normal to have swelling for 8 - 12 weeks after the operation. This will slowly resolve with time.

If you are concerned about any of these symptoms please discuss them with Dr Schluter at the clinic visit.

What if I have concerns after my surgery?

Please do not hesitate to contact Dr Schluter’s rooms or your GP if you develop any of the following:

  • Heavy bleeding through the cast.

  • Sudden severe pain or tenderness at the wound site or in the joint.

  • Swelling in the calf or thigh, especially if associated with pain or heat

  • Redness around the incision that continues to spreads.

  • Temperature higher than 38.5 °C (fever) or chills.

  • Any concerns you may have regarding your recent surgery