First MTP Fusion Surgery

This surgery is indicated for big toe arthritis from any cause, or large bunions that need a powerful correction. This involves removing the cartilage from the big toe joint (MTPJ) and compressing the bones together with plates and screws.

The operation is performed via an incision on the inside part of the foot (medial), the tight soft tissues pulling the toe are released, the cartilage and hard arthritic bone is removed, position of the toe is improved and then the joint is fixed rigidly with a plate and screws. X-ray guidance is used throughout the procedure to ensure alignment is excellent.

Figure 1: pre operative and intraoperative Xrays demonstrating a first MTP fusion operation

The operation is performed via an incision on the inside part of the foot (medial), the tight soft tissues pulling the toe are released, the cartilage and hard arthritic bone is removed, position of the toe is improved and then the joint is fixed rigidly with a plate and screws. X-ray guidance is used throughout the procedure to ensure alignment is excellent.

Success rates: 92-96% of patients have a successful outcome with this procedure[1]

Post-operative

  • Surgery is a day-stay or overnight.

  • A block of the foot is performed to help with post-operative pain.

  • 0-2 weeks: elevation at home to reduce swelling

  • 2-4 weeks: walking on the flat of the foot in a stiff soled shoe

  • 4-6 weeks: walking in a comfortable shoe, on the flat of the foot

  • 6-12 weels: focusing on heel-toe walking

  • 12 weeks onwards: strengthening and return to full activity

Download post operative care guide

 

Risks of surgery

  • Swelling, stiffness

  • Infection

  • Wound healing problems or infection

  • Scar sensitivity

  • Ongoing pain

  • Secondary surgery such as removal of screws

  • Removal of hardware is requested by patients in approximately 10-15% of cases, this typically happens >1 year after initial surgery.[2]


[1] Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? The Journal of Foot and Ankle Surgery. 2023 Sep;62(5):905–11.

[2] Donegan RJ, Blume PA. Functional Results and Patient Satisfaction of First Metatarsophalangeal Joint Arthrodesis Using Dual Crossed Screw Fixation. The Journal of Foot and Ankle Surgery. 2017 Mar;56(2):291–7.