MTP Joint Fusion
Arthritis of the big toe joint (first metatarsophalangeal or MTP) can cause pain and swelling. This can produce the classic bulging of the joint which often makes it uncomfortable to walk or wear certain footwear. Arthritis develops when the cartilage which acts as the cushion and lubricant in the joint wears away and the two bones that make up the big toe joint rub against one another.
This operation removes the degraded part of the joint and fixes the joint together using a plate, with the aim that new bone will grow across and 'fuse' the joint. The joint will then be rigid and no longer painful. However, it should not alter normal walking significantly.
The surgery is routine, but the recovery can be prolonged and swelling is the last feature to disappear. Your normal shoes will still be a tight fit at the 6-week stage and it will be 3-4 months before walking is completely comfortable.
Risks of surgery
Initially the foot will be very swollen and needs elevating. The swelling will disperse over the following weeks & months but will still be apparent at 6-9 months.
There is always a risk of infection with surgery. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for at least 10 days. You will be given 1 dose of intravenous antibiotics during surgery and if there there is an infection, it normally resolves with a course of oral antibiotics.
The surgeon works hard to ensure the toe is fused in a position that allows optimum function and gives the best appearance. In the theatre we place your foot on a flat panel to simulate the normal standing posture of the foot. However, as you are asleep and lying down rather than standing with your whole weight on the foot, there is an element of experience and judgment in estimating the 'perfect' position. Occasionally, once the swelling has settled down, you may find the toe is fractionally higher or lower than before. This rarely causes a problem that requires further surgery and is usually accommodated with insoles.
This is when the joint fails to fuse and bone has not grown across the joint. If this is painful then further surgery may be needed. The risk of this is approximately 10%.
Recovery from surgery
All things being normal, you can be discharged from hospital the same day, or the following day after surgery.
This type of operation and the post operative shoe allow weight bearing (walking) immediately. Often this may be too uncomfortable for the first week. Crutches are usually necessary for the first for 4-6 weeks.
The fusion must be protected with the specialised dressing for 2 weeks and you will need to wear a post operative shoe for 6 weeks.
Elevation of the foot (above the pelvis) for the first 10 days is vitally important to prevent infection. Naturally, small periods of walking and standing are necessary.
Activity and time off work
In general, up to 2 weeks off work is recommended if you have an office or sedentary job. Jobs or activities that involve a lot of standing or walking require a break of 6 weeks and more strenuous roles such as farming or construction where stresses are put on the joints, up to 8 weeks.
- 2 weeks for removal of sutures
- 6 weeks in Mr Rosenfeld's clinic - weight bearing X-ray
- 3 months for final review
X-rays may be taken at each visit to evaluate the bone healing and the position of the big toe.