28755 Arthrodesis, great toe; interphalangeal joint

Name of the Procedure:

Arthrodesis, Great Toe; Interphalangeal Joint (also known as Interphalangeal Joint Fusion or IP Joint Fusion of the Great Toe)

Summary

Arthrodesis of the great toe interphalangeal joint is a surgical procedure that fuses the bones of the great toe at the interphalangeal joint, eliminating movement in that joint to provide pain relief and increase stability.

Purpose

This procedure addresses severe arthritis, deformities, or injuries in the interphalangeal joint of the great toe that do not respond to conservative treatments. The goal is to alleviate pain, correct deformities, and improve overall foot function by stabilizing the great toe.

Indications

• Persistent pain in the great toe due to arthritis or trauma.
• Severe deformities such as hammer toe or claw toe.
• Joint instability or dislocation.
• Failure of non-surgical treatments like medications, orthotics, or physical therapy.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, including discontinuation of blood thinners.
• Diagnostic tests like X-rays or MRI scans to assess the condition of the joint.
• Pre-operative clearance from a primary care physician.

Procedure Description

1. The patient receives anesthesia, which can be local, regional, or general.
2. An incision is made on the top or side of the great toe to expose the interphalangeal joint.
3. The cartilage surfaces are removed from the bones of the joint.
4. The bones are positioned to encourage proper alignment and then secured with surgical hardware like screws, plates, or wires to ensure they fuse correctly.
5. The incision is closed with sutures, and a sterile dressing is applied.
6. The toe is often immobilized with a splint or cast to facilitate healing.

Duration

The procedure typically takes 1-2 hours.

Setting

This surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon or podiatric surgeon.
• Anesthesiologist or nurse anesthetist.
• Surgical nurses and technicians.

Risks and Complications

• Infection.
• Non-union or delayed union of the bones.
• Nerve damage.
• Blood clots.
• Complications with anesthesia.
• Recurrence of toe deformity.
• Pain or discomfort at the surgical site.

Benefits

• Significant pain relief.
• Correction of deformities leading to better foot function.
• Improved stability and ability to wear shoes comfortably.
• The benefits are typically realized within a few months post-surgery.

Recovery

• The foot will be in a splint or cast for several weeks to maintain immobility.
• Pain and swelling management with medications and elevating the foot.
• Gradual weight-bearing and mobility as advised by the physician.
• Physical therapy may be recommended.
• Full recovery can take several months, with follow-up appointments necessary to monitor healing.

Alternatives

• Non-surgical treatments like orthotic devices, physical therapy, or medication.
• Less invasive procedures like joint injections.
• Toe realignment or osteotomy.
• Pros: Less invasive alternatives may have shorter recovery times and lower risks.
• Cons: They may not provide lasting relief or stability as effectively as arthrodesis.

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. Post-operatively, patients can expect some discomfort and pain, which is manageable with prescribed medications. Swelling and stiffness are common but will subside over time. It's essential to follow all post-op care instructions to ensure a smooth recovery and achieve the best outcome.