Fusion of the 1st MTP joint


The operation is usually offered in severe cases of arthritis of the big toe MTP joint.

What does the operation involve?

The operation is done as a day case, but come prepared in case you need to stay overnight.

The operation is performed with general anaesthetic and nerve block (which means numbing the nerves of the foot).

The operation involves one incision over the base of the big toe. The abnormal extra bone around the joint is trimmed. The remaining cartilage on the joint surfaces is removed and the joint is fixed using metal staples, screws or a metal plate.

You are given crutches if needed.

Your post-operative period

  • You must keep your foot raised for the first two weeks and when necessary afterwards
  • You can put partial weight on your foot using the surgical shoe
  • Use crutches
  • Avoid any bending forces on the big toe
  • The swelling comes and goes and can last for a long period up to six months.


Your follow-up

  • At two weeks, the dressing is reduced and stitches are removed
  • At six weeks for x-rays
  • Off work for about six – eight weeks, depending on your job.


What are the possible complications?

  • Infection
  • Ongoing pain
  • Cock-up position of the big toe
  • Failure of bone healing (non-union)
  • Sensitive or painful scar
  • Big toe permanent numbness
  • Clots in the leg (DVT)
  • Clots in the lung (PE)
  • Chronic Regional Pain Syndrome
  • After this operation, walking uphill is usually difficult and some patients require shoe-wear modification.

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood thinning medication increases possible risks significantly.