1st MTP joint surgery

What is a first MTP joint fusion?

Arthritis of the first metatarsophalangeal or MTP joint (the big joint of the big toe) can cause pain and swelling. This can lead to difficulty with shoewear and mild activity such as walking. Arthritis develops when the cartilage in the joint wears away and the two bones that make up the big toe joint rub against one another.

What are the goals of a first MTP joint fusion?
The goal of this procedure is to join (fuse) bones together permanently. By doing this, the joint is gone and the arthritis pain

What signs indicate surgery may be needed?
The need for surgery depends on how bad the arthritis is. Surgery is recommended for those with pain in the big toe joint and stiffness in the toe. Some patients are unable to wear certain shoes (dress shoes, high heels and boots) and can’t participate in activities due to pain. If the condition exists in both feet, the more painful foot is operated on first.

An orthopaedic foot and ankle surgeon can determine the severity of the condition. Before deciding on surgery, conservative treatment should be attempted. This includes changes in activity and footwear or steroid injections. Patients can also try wearing a shoe with a rounded bottom or using carbon shoe inserts that limit joint motion.

When should I avoid surgery?
You should avoid surgery if you have an active infection or severe narrowing of the arteries. You must be able to manage a recovery period that can last up to six months.

General Details of Procedure
The entire surgery is performed in about two hours and you may go home on the same day.

Specific Technique
An incision is made on top of the big toe. Remaining cartilage is cleared away to allow the two bones to heal together. Your orthopaedic surgeon may use a combination of tools to shape each bone for a perfect fit.

Once prepared, the two bones are positioned and a metal plate is placed to hold both bones together. An additional screw is driven across the joint for extra stability and compression, which stimulates healing. Also, two screws can be placed across the joint without using a plate. After the hardware is placed, the incision is closed with sutures and the foot is placed in a dressing or splint.

What happens after surgery?
You will likely be examined at two weeks, six weeks, three months and six months. X-rays may be taken at each visit to evaluate the bone healing and the position of the big toe. Weight bearing status will be determined by your surgeon. After a first MTP fusion, you should not wear shoes that put extra stress on the joint.

Potential Complications
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Common complications specific to MTP fusion include poor or delayed bone healing, infection, and stiffness in neighboring joints. The metal plate used during surgery can sometimes cause irritation. In this case it can be removed after the bone has healed. Finally, scarring within the joint can limit neighboring tendons.

Frequently Asked Questions

If I have a first MTP fusion, will I have a limp when I walk?

Most people with a first MTP fusion do not have a limp after it has fully healed.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the “Find an Orthopaedic Foot & Ankle Surgeon” tool at the top of this page or contact your primary doctor.