1st MTPJ fusion

Hallux rigidus surgery, 1st metatarsophalangeal joint fusion, 1st MTPJ arthrodesis
Summary

This operation is performed for symptoms caused by arthritis of the 1st metatarsophalangeal joint, also known as hallux rigidus.  This joint is the “knuckle” joint of the big toe.  Increasing pain and stiffness occurs as the joint surfaces get damaged. With worsening arthritis, the pain can get so bad that it interferes with your life. Pain killers may not help anymore and you struggle to walk any distance with severe pain as you “toe off” when walking.  Surgery involves removing the joint surfaces and fusing the joint to prevent any movement in the joint. This does stiffen the joint further but has the benefit of eliminating pain from the joint.

Factors to Consider

You have been diagnosed with hallux rigidus. It is likely that you have already tried non-surgical treatments for your foot such as pain killers, footwear modification, physiotherapy and injections.  

If these measures have not improved your symptoms then the next logical step is to consider surgery. A 1st MTPJ fusion, in which the joint surfaces are fused together, is the definitive surgical option for patients.  Some patients may, however, be more appropriate for a dorsal cheilectomy or a Cartiva procedure. Your surgeon will discuss what the best option for your foot would be.  

Description of Surgery

The operation can be performed as an open procedure or through a minimally invasive approach.  Open surgery is required for more severe cases.  The remaining joint cartilage is removed and the joint surfaces are pressed together and held with screws.  

The operation takes about 45-60 minutes.

Anaesthetic

The operation is usually performed under a general or spinal anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is a failure of fusion and consequently failure of fixation.  The surgeon is attempting to fuse two bones together which naturally are not fused.  Surgery provides the stability for the fusion to occur but you need to provide the “biology” to ensure the bones fuse together.  Smoking can affect this and so you should stop before surgery if you do smoke.  

The risk of infection is small and is thought to be about 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Any surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a bandage with a heel weight bearing shoe.  This is a shoe that only allows you to put weight through the heel, thus protecting the fusion.  It is likely that you will need a heel weight bearing shoe for the first 6 weeks.  The surgeon will give you instructions as to when you can start to fully weight bear as this will depend on the appearances on the Xray.  

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you once you are fully weight bearing.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but should not be before 6 weeks unless it is your left foot and you drive an automatic car.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 12 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that “it takes 3 months to be fair, 6 months to be good and 12 months to be right”.