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The big toe joint (first metatarsophalangeal joint) is the joint that connects the great toe to the first metatarsal. It is a common area where painful arthritis can develop.
Who Needs a Great Toe Joint (Mtp) Fusion?
If you have painful arthritis in the big toe joint of the foot, you may need an arthrodesis (fusion) procedure. Other indications for surgery is if you have a big painful bunion, or a history of great toe injuries that have resulted in joint damage.
First metatarso-phalangeal joint (MTPJ) fusion is usually performed when conservative treatment (such as orthotics, pain medication, and steroid injections) have failed.
In this case, your doctor may suggest surgery to reduce pain.
What Does the Surgery for Joint Fusion Pain Involve?
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 leg. You will then be discharged from the hospital.
The surgery will take 1-2 hours to complete.
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.
How Many Weeks Does It Take To Fully Recover After a Great Toe Joint Operation for Arthritis?
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.
Prematurely bearing weight on the foot can cause the hardware to break and the fusion site to become disrupted.
Complications of 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.
Tendon rupture: A complication that could happen during or after the surgery is extensor tendon rupture. The hardware in the great toe joint can cause the tendon that courses over it to tear.
This can cause inability to raise the great toe. If this is the case, your doctor will need to repair the ruptured tendon.
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 prior 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?
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 the treatment?
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 Hallux After A Fusion?
You cannot move the big toe after a 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 A Fusion?
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.
In conclusion, a fusion surgery of the big toe joint offers a promising solution for those suffering from painful hallux due to osteoarthritis. While the procedure involves a significant recovery period, by adhering to your doctor instructions and maintaining regular check-ups at the clinic, you can optimize your healing process.
Pain medicine will be a crucial component of managing your postoperative discomfort. After a successful big toe fusion, patients usually report a significant decrease in pain and an overall improvement in their health.
However, like any surgical intervention, the potential for complications does exist, highlighting the need for ongoing communication with your Podiatrist or an Orthopaedic foot and ankle surgeon who specializes in surgery of the foot and ankle joint. Check their surgery policy and see if they offer minimally invasive surgery.
Ultimately, a fusion surgery can provide a dramatic change in the quality of life for those debilitated by the chronic pain of an arthritic big toe.
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