LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Big Toe (Hallux) 1st MTP Joint Fusion Surgery

How is the surgery carried out?

It is a day-case procedure. The operation is done under a general anaesthesia and an added injection in the foot to numb it for after surgery. The operation will involve 1 incision on the top of your big toe about 4cm long. The procedure involves removing the painful damaged joint and the bumps of bone around the joint. The metatarsal bone is then attached to the phalanx bone and held firmly with a metal screw and plate that stay in long term. Dissolvable skin stitches are used.

Big Toe Mtp Surgery

What to expect immediately after surgery in hospital

Your foot will be bandaged, numb and pain free. You will see a physiotherapist who will advise on mobility in a padded stiff shoe supplied. You will be discharged only when comfortable with an appointment and pain-killers as required.

Recovery in first few weeks after surgery

  • Elevate you foot as often and as much as possible to reduce swelling.
  • Mobilise as instructed, but only for necessity indoors and outdoors.
  • Some blood ooze can be expected in the bandage, if worried contact the Consutlants clinic.
  • Take pain-killers as prescribed.
  • Avoid smoking and anti-inflammatory medications such as Ibuprofen or Voltarol. 

Post-operative clinic schedule

  • 2 weeks - Remove bandage, clinical examination
  • 6 weeks - Remove shoe, clinical examination and X-Ray
  • 12 weeks - Clinical examination and X-Ray, discharge

When can I start to walk?

  • 0-6 weeks - Full weight-bear in hospital shoe
  • > 6 weeks - Full weight-bear in normal shoes

How do I wash and shower? 

In the first 2 weeks keep the bandaging totally dry. You may shower with a waterproof cover over the foot. After 2 weeks you can only shower if the wound is healed but gently dab the wound dry.

How can I look after the wound?

Once out of bandaging, do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore you need to see your Consultant to ensure there is no infection present. Your physiotherapist may advise on wound massage.

Physiotherapy and Rehabilitation

Your physiotherapist will guide you through the stages of rehabilitation including gait re-education, swelling reduction and reducing muscle tightness. It is important to adhere to advice given. 

When can I start to drive again?

DVLA states it is the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car in an emergency stop. This will take at least 6 weeks. Click here to read DVLA guidance.

When can I work?

This is very individual and job-dependent. Below is a guide:

  • Sedentary 4 weeks
  • Manual labour 8 weeks

What long-term outcome can I expect after surgery? 

Excellent pain relief is noticed quite quickly which improves until the toe has fused, which can take 3 months. Good level of activity and sports is expected by 6 months. It will take 12 months to be fully recovered. It is a very successful operation with excellent outcomes in over 90%. Mild swelling can persist in the foot for up to a year.

What are the risks?

Any operation carries a risk. Below is a guide to some risks potentially encountered. It is the surgeons duty to fully inform you of possible risks. Mr Roche will ensure this is always done so patients can make safe and informed choices about their operation.

Infection

If this happens, it is usually simply treated with antibiotics. Significant consequences from infection are very rare but can be dealt with. Risk is around 1%.

Nerve damage

Nerves that supply sensation to the skin are near the incision site. Damage is rare but if your toe stays numb after surgery, the nerve may be bruised. If so it usually recovers. Risk is around 5%. 

Non-union

This means the bones fail to biologically fuse. Occasionally it can be “painless” and intervention may not be needed. If painful, then treatment options will be discussed, including further surgery. Risk is around 5-10%.

Prominent metalwork

Sometimes the metal can be prominent and once the bones have fused, usually after 6 months the metal can easily be removed with a small day-case operation.

Deep Vein Thrombosis

Symptomatic clot formation in the leg is unusual after foot and ankle surgery (<3%). Whether treatment to prevent clot is needed can be discussed with your surgeon. There is no consensus amongst UK Orthopaedic surgeons as to whether preventative medicine is needed.

PLEASE REMEMBER...

Certain things may delay or even prevent the bones from fusing together. You must try to avoid them. This includes:

  • Non-steroidal Anti-Inflammatory tablets (NSAIDS)
  • Smoking
  • Failure to follow medical instructions (especially weight-bearing instructions)

Important last note

This document is only meant to be a guideline to help you understand your treatment and what to expect. Every person is different and your rehabilitation may be quicker and slower. This will be advised and guided by your doctor and physiotherapist.

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road