Saturday, April 01, 2023
Forefoot Surgery SURGERY

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If you have painful arthritis in the great toe joint of the foot, you may need an arthrodesis (fusion) procedure. The first metatarsophalangeal joint (the joint that connects the great toe and the 1st metatarsal) is a common area where painful arthritis can develop. 

Also, if you have a severe bunion with arthritis in the great toe joint, your doctor may suggest fusion surgery. 

First metatarsophalangeal joint (MTPJ) arthrodesis is usually performed when conservative treatment (such as orthotics, pain medication, and steroid injections) has failed. In this case, your doctor may suggest surgery to reduce pain. 

great toe joint pain xray

Great Toe Joint Fusion Surgery- What to Expect

The surgery is performed in the outpatient setting. This means that you can go home the same day after the surgery. 

Your doctor will excise arthritic spurs from the great toe joint and clean out any remaining cartilage from the joint space. Then, he/she will reduce the great toe joint onto the first metatarsal in proper alignment. The fusion site will be fixated using plates/screws or staples. Suture (thread) will be used to close the incision site.

The goal of surgery is to eliminate motion at the joint, and thus eliminate pain in the joint. 

After the surgery is finished, your doctor will apply a posterior splint/cast on your limb. You will then be discharged from the hospital.

The surgery will take 1-2 hours to complete. 

Great Toe Joint Fusion Recovery- What to Expect

Once you are discharged you will have a postoperative appointment scheduled with your doctor. At that time, your doctor will take down your surgical dressing and provide you with instructions moving forward. Postoperative radiographs will be obtained. 

You will need to elevate your surgical limb on a pillow to help reduce swelling. Icing the foot can help reduce pain. Ice the foot for 20 minutes on and off. If your dressing is bulky, you can apply ice behind your knee. Ice helps to constrict the blood vessels in the foot and reduces pain. 

You should keep your surgical cast dry while in the shower for the first couple of weeks after your surgery. You can obtain a cast protector from Amazon to help keep your cast dry.

You will need to remain non-weight bearing on the surgical foot for 6-8 weeks after the procedure to allow for the fusion site to heal. This will then be followed by gradual weight bearing in a cast boot for 2-4 weeks followed by athletic shoes. 

Full recovery after a great toe joint fusion can take anywhere from 8 weeks to 12 weeks. Your doctor will obtain radiographs of your foot after surgery every 3-4 weeks to make sure your fusion site continues to heal appropriately. 

In addition, your doctor may suggest you go to physical therapy 3 times a week for 1 month to help reduce pain, regain strength and improve balance. 

To help you stay off of your foot during the early recovery period, you can obtain a knee scooter or crutches. You can buy both on Amazon. 

Prematurely bearing weight on the foot can cause the hardware to break and the fusion site to become disrupted. 

foot bandage after surgery

Complications of the Great Toe Joint Fusion Surgery

Infection: Infections can occur at the incision site or even internally if bacteria were to enter the body during the surgery. It’s important to take care of the incision site and keep it clean to avoid infection. If you notice any redness, swelling, or pus coming from the incision, be sure to notify your doctor right away as this could be an indication of infection.

Your doctor will recommend antibiotics to clear the infection

Nonunion: A nonunion is when the fusion site doesn’t heal after 3 months. This can occur due to inadequate reduction or poor blood supply at the fusion site. Risk factors for a nonunion include positive smoking history, diabetes, and older age. A nonunion can be painful.

Your doctor may suggest you use an external bone stimulator to help heal the nonunion site or may recommend repeat surgery to clean and re-fixate the nonunion site. 

Nerve injury: Another potential complication from this surgery is nerve damage. The nerves in the foot are very delicate and can easily be damaged during surgery. This can lead to numbness, tingling, or even complete loss of feeling in the affected area. In most cases, nerve damage is temporary, however, in some cases may be permanent. 

Blood clots: Another possible complication from this surgery is blood clots. When your leg is in a cast for a long time, the chance of developing a Deep Vein Thrombosis (DVT) is higher. The risks of a blood clot include a previous history of a blood clot, a history of smoking, and taking birth control.

If you develop sudden calf pain, redness, or swelling in the leg, contact your doctor right away or go to the Emergency Department. 

Can You Drive After Foot Fusion Surgery?

You will need to refrain from driving for about six to eight weeks after the procedure. You cannot and should not drive with a cast on. Driving with a cast on is dangerous. Check with your doctor before you start driving. 

Can You Wear Normal Shoes After a Big Toe Fusion?

Although you can wear many different kinds of shoes after your great toe joint is fused, it’s best to avoid wearing very high heels. This is because after a great toe joint fusion, you cannot bend the great toe joint. Wearing excessively high heels can cause unnecessary pressure on the fusion site. Aim to wear heels that are no higher than 1 inch tall.

Can You Move Your Big Toe After Fusion?

You cannot move the metatarsophalangeal joint after a metatarsophalangeal joint fusion procedure. However, you can move the joint next to it (interphalangeal joint) in the big toe. 

How Long Should You Be Off Work After Fusion Surgery?

If you work a desk job, your doctor may allow you to return to work 2-3 weeks after surgery once sutures come out. You will need to stay off of the foot and keep your leg elevated on a chair to help reduce swelling in the surgical foot. You should not work while taking narcotic pain medications. 

If your job requires you to stand all day long or walk, you may need to take 6 to 8 weeks off work after surgery to ensure the fusion site is fully healed. 

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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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