What is a First MTP Joint Arthrodesis (Big Toe Fusion)?
First MTP joint fusion (commonly known as big toe fusion) is a surgical procedure that treats painful arthritis, deformities like bunions, or stiffness in the joint at the base of the big toe. This joint, called the first metatarsophalangeal (MTP) joint, plays a critical role in walking, balancing, and bearing weight.
Preparation
Before surgery, your orthopedic foot and ankle specialist will conduct a physical exam and take X-rays of your foot to understand the extent of joint damage, and ensure the procedure is right for you. You may be asked to stop certain medications or supplements temporarily before the operation. Your doctor will also give you guidance on arranging transportation and preparing your home for recovery, since you’ll need to keep weight off the foot for a period afterward.
Removing Bony Growths
During the procedure, your surgeon will first access the joint through a small incision over the top of your big toe. Any arthritic or damaged cartilage is carefully removed. If bone spurs or excess bone growths are present, they are also shaved away, as they are often a source of pain, and to allow for a smoother fusion.
Inserting the Implant
Once the joint surfaces are properly prepared, the surgeon aligns the bones in a corrected position. A small implant, often a metal plate and screws or a compression device, is used to hold the bones together while they fuse naturally over time. The implant stays in place permanently and provides the stability needed for healing.
This corrected alignment improves the position of your big toe and allows for a more natural walking pattern after recovery.
End of Procedure and Aftercare
The incision is closed with sutures, and your foot is bandaged and placed in a post-op boot or splint. You’ll be monitored for a short period of time before going home the same day, in most cases.
Recovery from big tow fusion takes time, but we’ll guide you every step of the way. Here’s a general timeline:
- Weeks 1-2: Rest, elevation, and no weight-bearing. Pain is managed with medication and ice.
- Weeks 3-6: Continue keeping weight off the foot. Attend follow-up visits for progress checks.
- Weeks 6-8: imaging may confirm fusion progress. Careful, gradual return to weight-bearing may begin.
- Weeks 10-12: Most patients return to comfortable shoes and regular activity with little or no pain.
- Ongoing: Some stiffness is expected, but function and comfort improve significantly.
FAQs
If you’re experiencing persistent pain, swelling, or stiffness in your big toe, and it affects how you walk or limits your daily activities, it’s time to see a specialist. Big toe arthritis can worsen over time, and early treatment may help prevent more serious problems later on.
A first MTP joint fusion typically takes about 60 to 90 minutes. It’s usually done as an outpatient procedure, so you’ll go home the same day to begin your recovery.
As with any surgery, there are some risks. These may include:
– Infection
– Blood clots
– Delayed or failed bone healing (nonunion)
– Implant-related discomfort
However, complications are relatively rare, and your surgeon will take steps to reduce these risks and guide you through a safe recovery.
Most people are back to wearing regular shoes and going light activities within 10 to 12 weeks. Full healing, including bone fusion, may take a few months. You’ll likely be non-weight-bearing for the first 6 to 8 weeks, and then generally resume walking as healing progresses.
It’s common to temporarily limp while recovering – especially during the non-weight-bearing phase. Once the joint fuses and you’ve had time to regain strength and balance, most people walk with a normal gait and significantly less pain than before the surgery.
Running isn’t impossible after big toe fusion, but it may feel different. Because the joint no longer bends, activities that require push-off through the big toe (like sprinting or jumping) can be limited. Some people return to light jogging or sports with modifications, but others prefer lower-impact activities. Your doctor can help guide you based on your goals and lifestyle.
