Name of the Procedure:

Arthrodesis, great toe; metatarsophalangeal joint
Common name(s): Big toe fusion, MTP joint fusion

Summary

Arthrodesis of the great toe is a surgical procedure that permanently joins (fuses) the bones of the metatarsophalangeal (MTP) joint, typically to alleviate severe pain and improve function in the big toe.

Purpose

The procedure addresses conditions such as severe arthritis, deformities, or joint damage in the MTP joint. The goal is to relieve pain, enhance stability, and improve the overall function of the big toe.

Indications

• Persistent and severe pain in the MTP joint
• Advanced arthritis that is unresponsive to conservative treatments
• Deformities such as hallux rigidus (stiff big toe)
• Failed previous treatments or surgeries
• Patients with impaired mobility due to MTP joint issues

Preparation

• Patients may need to fast for a certain period before surgery, typically starting the night before.
• Medication adjustments may be required, especially anticoagulants.
• Preoperative assessments, including blood tests and imaging (X-rays or MRI), to evaluate the joint condition.

Procedure Description

1. The patient receives regional or general anesthesia.
2. An incision is made over the MTP joint of the great toe.
3. The surgeon removes any remaining cartilage and prepares the bone surfaces.
4. The bones are positioned correctly and fixed together using screws, plates, or other hardware to ensure proper fusion.
5. The incision is closed with sutures, and a bandage is applied.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic surgeon or podiatrist specializing in foot and ankle surgery
• Operating room nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Nonunion (bones not fusing properly)
• Hardware irritation
• Reduced range of motion in the toe

Benefits

• Significant pain relief
• Enhanced joint stability
• Improved function and alignment of the big toe
• Better weight distribution while walking

Recovery

• Patients typically need to keep weight off the foot for several weeks using crutches or a walker.
• A cast or boot may be worn to protect the foot.
• Postoperative instructions often include elevation of the foot and taking prescribed medications.
• Follow-up appointments for X-rays to monitor bone healing.
• Full recovery and return to normal activities can take several months.

Alternatives

• Non-surgical treatments such as orthotics, physical therapy, or medication injections
• Less invasive surgeries like cheilectomy or joint resurfacing
• Pros: Less invasive, quicker recovery
• Cons: May not provide long-term relief, risk of recurrence

Patient Experience

During the procedure, patients are under anesthesia and will not feel pain. Postoperative pain and swelling are managed with medications and rest. Patients might experience some discomfort during the recovery phase, but effective pain management and care measures are provided.