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

Hallux MTP Replacement

How the surgery is carried out

Hemicap 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 surface on the metatarsal bone only. The end of the metatarsal bone is then resurfaced using a metal dome that adheres firmly to the bone. This new joint surface allows normal movement in the joint. Dissolvable skin stitches are used.

Hallux Mtp Replacement

What to expect immediately after surgery

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 and given a follow-up 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 Consultants clinic.
  • Take pain-killers as prescribed.

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
  • 6 months - Clinical examination, X-Ray and possible 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 when its healed.

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.

  • 0-2 weeks - Begin gentle active and passive mobilisation of the toe in the bandage
  • 2-6 weeks - Increase active and passive mobilisation of the big toe with physiotherapy
  • >6 weeks - Gradually increase your toe movements and resistance exercises with physiotherapy

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 3 weeks
  • Manual labour 12 weeks

What long-term outcome can I expect after surgery?

Good pain relief as the wound heals and the toe begins to loosen up. The toe will gradually move more and by 3 months may be quite mobile. Good level of activity and sports by 6 months. 12 months to be fully recovered. It is a very successful operation with generally very good outcomes. 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

Fortunately quite rare but can potentially be a difficult problem to treat if deep inside the big toe joint that may need further surgery. Your surgeon should advise on this before the surgery. 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%.

Toe stiffness

Although the operation is designed to retain movement, some patients may not regain all movement. Physiotherapy can assist with this.

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.

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