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Big Toe (Hallux) 1st MTP Joint Fusion Surgery

This type of surgery is normally a day case procedure, carried out under a general anaesthetic (with a local anaesthetic to relieve pain around the joint after surgery). It’s used to treat big toe arthritis.

What does surgery involve?

It involves making a small cut (incision) on top of the big toe and removing damaged bone before fixing (fusing) the joint using a tiny screw and plate.

Before surgery

You can help improve the outcome of surgery by attending a pre-assessment screening where you’ll have blood tests to check for levels of Vitamin D and swabs to rule out infection or other problems. You’ll also be weighed and have an opportunity to discuss your medical history. This is important so that any anaesthetics problems can be identified.

Please note: it’s important to stop smoking at least eight weeks before your procedure; this is because smoking can affect the body’s ability to heal and causes health problems including an increased risk of blood clots forming in the lungs (pulmonary embolism) or calf (deep vein thrombosis).

What happens after surgery?

Your foot will be numb and pain-free (from a local anaesthetic injection around the affected area). A member of our physiotherapy team will help you to stand, supported by crutches, and will give you a tailored programme of exercises to help you walk correctly in a padded stiff shoe that supports your toe.

In most cases, you’ll be given painkillers to take for a few days and offered a series of follow-up appointments:

  • At around two weeks the bandage may be removed
  • At six weeks your supportive shoe will be removed and you’ll be given an X-ray to check progress
  • At 12 weeks you will normally have your final appointment

Please note: it’s important to avoid smoking or taking anti-inflammatory painkillers as these can slow the healing process.

How can I speed up my recovery?

It’s important to follow any advice you’ve been given about keeping the wound clean and dry, along with keeping your foot raised above the level of your heart as much as possible to help reduce swelling. It’s also a good idea to keep weight off the foot for a few days and take any painkillers you’ve been prescribed. Make sure you carry out the exercises advised by your physiotherapist as these will help you to return to your normal activities as quickly as possible.

When can I drive again?

The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is when you can stamp down hard with the foot to stop the car during an emergency stop. How long this takes will vary, depending on how quickly you recover.

Although Mr Heidari will advise you about when it’s safe to start driving again, it is your own responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

When can I return to work?

This varies, depending on the type of work you do and the speed of your recovery. In most cases, if you have a sedentary job (sitting down most of the time), you should be able to return after around four weeks. If your job involves manual work, you may need up to eight weeks off.

What are the risks of this type of surgery?

  • All surgery carries risks. With this type of surgery there is a small chance of infection which can be treated with antibiotics
  • In a few cases, the bones don’t heal correctly which may mean you need further surgery
  • Metalwork used to fuse the joints can stick out; however, this can be removed once the joint has fused
  • There is a small chance of deep vein thrombosis (DVT) following any surgery, although this is unusual following this type of surgery. However, you may be given blood-thinning medication after surgery as a precaution or if you are at higher risk. You will also be given support socks and exercises to reduce the chances of DVT

You can find more information about recovering from big toe joint fusion surgery in our patient information leaflet, which can be downloaded from this website.