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1st MTP Joint Fusion
(Hallux Rigidus)

First Metatarsophalangeal (1st MTP) Joint Arthroplasty or Fusion, with soft tissue release.

The operation can be performed comfortably under a local anaesthetic block, which is achieved by either a series of injections around the ankle, or an injection behind your knee. You will be fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain.

Aims of Surgery

  • To reduce pain and deformity.
  • To improve the alignment of the big toe (make it straighter).

Advantages of this Operation

  • Reduces pain by eliminating movement in the joint.
  • Provides a more predictable outcome.
  • Definitive procedure.

Specific Risks of this Operation

  • Pressure lesion to the big toe.
  • Arthritis in the smaller joint of the big toe.
  • Poor alignment.
  • Damage to nerves, tendons, or blood vessels.
  • Deep vein thrombosis or pulmonary embolism.
  • Delayed or non-union of bone (bone does not knit together).
  • Problems with fixation (screws/plates).
  • Transfer of pressure to the ball of the foot.
  • Potential need for further surgery.

Operation Time

  • Usually between 45 and 60 minutes.
  • Incision placement/stitches are usually on the top of the toe, using absorbable stitches where possible.

Indications for the procedure

  • Painful, unstable, or arthritic 1st metatarsophalangeal joint.
  • Difficulty with shoe fit despite wearing sensible footwear.
  • Failure of alternative treatments, e.g. orthotics/injections.

Procedure

  • The bony surfaces on either side of the big toe joint are debrided to remove the worn-out cartilage.
  • The raw bone surfaces are then held together to allow fusion (healing together).

Fixation

Internal fixation (bone screws, plates, or wires) is used to hold the bone together. These will not be noticeable and typically do not need to be removed (<20% of cases).

Will I Have Plaster?

No, you will be provided with a special shoe to wear following the surgery.

Is This a Day Procedure?

Yes, you will go home the same day.

Estimated Time Off Work

  • Non-manual work: approximately 4 weeks.
  • Manual work: 5–6 weeks.

Alternative Treatments

  • Manage symptoms by altering activity levels, using painkillers and anti-inflammatories, extra depth/width shoes, rocker sole (stiff curved sole), using an insole or orthotic foot support, and joint injection therapy.
  • Other surgical options include 1st MTP joint excisional arthroplasty or joint implant.

Post-Operative Care

First 2-4 days

  • This is the time you are likely to have the most pain, but you will be given painkillers to help. You must rest completely for 2–4 days.
  • You will be able to stand and take weight carefully on your other foot after the operation, but you must rest, with your feet up, as much as possible.
  • You should restrict your walking to going to the bathroom. When getting about, use your post op shoe in the way you will have been shown.
  • You can get about a little more after 3 days.

1 week after surgery

  • You may need to attend for your foot to be checked and redressed.
  • You may start to do a little more within your pain limits. An increase in pain can mean you are doing too much.

2 weeks after surgery

  • You may need to attend again. Sutures will be removed if necessary.

Between 3–5 weeks after surgery you will need to attend for a review and x-rays.

  • If the fusion site is healed, you will be advised to wear trainer type shoes and begin to walk fully.
  • The foot will still be quite swollen especially at the end of the day.
  • You may return to work but may need longer if you have an active job.
  • You may return to driving if you can perform an emergency stop. You must check with your insurance company and Mr. Cichero before driving again.

Between 8–12 weeks after surgery

  • The foot should continue to improve and begin to feel normal again.
  • There will be less swelling.
  • Sport can be considered after 3 months depending on your recovery.

6 months after surgery

  • You will have a final review between 3–6 months following surgery.
  • The swelling should now be slight and you should be getting the full benefit of surgery.

12 months after surgery

  • The foot has stopped improving with all healing complete.

Please note, if a complication arises, recovery may be delayed.

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For more information, questions or queries, please email us or call 01872 392087.

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