1st MTP Arthrodesis, or Fusion
Fusion of the first MTP joint, also called Arthrodesis, makes the great toe permanently stiff. During that procedure I generally place a metal plate and four or five small screws in the joint. That is done so that the two bones that make up the joint, the proximal phalanx and the metatarsal, will grow together into one solid bone. When that occurs, pain is eliminated from the first MTP joint. The trade-off is that there is no motion there after the fusion. Most people can walk well in a flat shoe, but you may have difficulty wearing a shoe with a heel higher than 1 inch.
The surgery is usually done as an outpatient, and you may have a General anesthesia, Spinal anesthesia, or Ankle Block.
Often, other forefoot procedures are done at the same time. These may include the same procedure on the opposite foot, hammertoe surgery neuroma surgery or reconstruction of a Rheumatoid Foot with a Clayton Procedure. This fusion is often done in patients with rheumatoid arthritis as part of a global forefoot reconstruction.
If this is done to salvage a previous operation that has failed, it may be necessary to harvest a bone graft.
Day of Surgery
At the end of the surgical procedure the wound is covered and the foot is wrapped with a dressing that is securely taped into place. That dressing gives support to the foot, and in particular the great toe, acting like a cast to hold it securely. That dressing should be left in place until I change it at the first post-operative office visit.
You will be given a post-operative shoe at the surgery center, and you may put all of your weight on the foot if you have that shoe on. You may be Full Weightbearing on the shoe as you can tolerate. You must not walk on the operated foot unless you are wearing the post-operative shoe.
Dealing with post-operative pain will be your major concern for the first few days.
The first post-operative visit is usually 7 – 10 days after surgery. I will remove the dressings, wash your foot, and take out the Skin stitches.
You will continue to use the post-operative shoe until 6 weeks have passed after the surgery. You may bathe the foot and keep a clean sock on it. You should not sit in a hot tub until 2 weeks after surgery. If your surgery was on the right side you should not drive until 6 weeks after surgery.
I will usually have an x-ray taken of the foot at the second postoperative visit, six weeks after surgery. This is done to evaluate the fusion, and make sure that healing is occurring well. Generally you will be allowed to resume wearing a regular shoe at the six-week point after surgery.
Swelling is generally present for about four months after the surgery. It usually takes 4 – 6 months for the foot to settle down.
The goal of surgery is to give you a painless foot that will allow you to do all activities without restrictions. How successful that will be is variable. It is usually possible to make the foot pain-free for daily activities. Some patients will have some mild soreness still. Most patients will notice discomfort when the weather changes.
You will find that the great toe will be about ½ inch shorter after the surgery because of the bone that is cut out about the joint. You will have a scar on the top of the toe that is 2 - 3 inches long.
Because of stiffness at the base of the great toe, you will not be able to wear a shoe with a heel higher than about 1 inch.
Complications can occur with any surgery.
Specific risks of this surgery include the possibility of the bone not healing, or non-union and implant problems.
As the swelling goes down sometimes the ends of the screws or plate can be felt along the top of the foot. Generally those are well-tolerated, but in some instances they do bother people with shoewear. If that is the case, once the fusion has occurred it may be necessary to remove the plate and screws with a second operation. Generally, they should stay in the rest of your life if they do not bother you.