First Metatarsal Phalangeal Joint Arthrodesis

Arthritis of the big toe joint (Hallux Rigidus) can make walking and even wearing shoes painful. Causes of this condition include degenerative arthritis, untreated bunions, trauma, and rheumatoid arthritis. Non-surgical options include stiff soled shoes and anti-inflammatory medication. When this problem becomes severe the best option may be to have a joint fusion. This surgery converts the stiff and painful joint to one that is stiff and nearly painless. Function improves because pain is relieved. The surgery is usually performed on an outpatient basis.

First Metatarsal Phalangeal Joint Arthrodesis
Hallux Rigidus

Pre-operative Care

The surgical center will inform you when to arrive and how to prepare for surgery. On the day of surgery, the anesthesiologists with give you a regional anesthesia known as a Popliteal nerve block. After you receive a medication through your IV to induce “twilight sleep” you will lie on your stomach and a small needle will be used to inject Novocain-like medication around the nerve in the back of your leg. It gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia.

Operative Care

You will be given antibiotics just before surgery to help prevent infection. During the surgery you will be kept in “twilight sleep,” unaware of time or sound. A tourniquet will be placed around your calf and an incision made on the top of the big toe joint. The spurs are removed and the bones of the big toe joint are roughened to simulate a fracture. Wires, screws, or plates may be used to stabilize the toe while it mends. X-Rays are taken to confirm bone position. The wounds are closed with stitches. Sterile dressings and post-operative shoes are applied.

Immediate Post-Operative Care

Once your anesthesiologist is satisfied that have recovered you will be permitted to leave the surgical center. During this recovery time, a family member may take your prescription to the nearest pharmacy. You will be given crutches and a walking boot. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wearing off. Remember post-operative pain is much easier to control with prevention. Call to schedule your post-operative visit when you feel able.

To schedule surgery, please contact my medical assistant at info@anklefootmd.com or 952-224-8500 at least four weeks in advance to best ensure your desired surgery date. If you have questions after surgery, please contact my office and ask for my medical assistant.

Post-Operative Course – First MTP Arthrodesis

This timeline is a general guideline. Your post-operative course may vary.

Elevation 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months.
Motion Move your ankle and lesser toes when the block resolves. This will decrease pain and swelling, and improve healing.
Walking Heel and outside of the foot only for 6 weeks. When the bones have healed, you may progress to a normal gait as you are able.
Bathing Do not soak incision for 2 weeks. After 3 days you may shower but do not let the skin by the incision become macerated. Since dirt from your body runs downhill you should clean this area last and dry it first. You may bathe at 2 weeks.
Dressing Keep dry and intact for 3 days then change it twice daily until drainage stops. After that use a Pedifix Compression Sleeve or Ace Wrap. Use the fracture brace or post-op sandal until bony healing is complete at an estimated 6-8 weeks.
Pain Control Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only).
Work Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take at least 3 months.
Driving Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe.

Routine Clinic Visits

2 weeks Check x-ray and confirm incision is healed.
6 weeks Check x-ray (earliest healing of fusion). Modify shoe wear and work restrictions. Gradually resume normal activity if bones are healed.
3 – 4 months Return if you have pain, other concerns, or per Dr. Silverman’s instructions. Minimal feelings of discomfort may linger, your overall comfort level improves over a year.
Other issues ardware removal is recommended if it is bothersome.
********** If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office.

Visit our video center to watch rehab exercise videos that will help you recover after your surgery.