First Metatarsal Phalangeal Joint Arthrodesis (Great Toe Fusion)

What is first metatarsophalangeal (MTP) joint arthrodesis?

MTP joint arthrodesis is used to address pain in the big toe. The procedure fuses the first metatarsophalangeal joint together.

What is the goal of this surgery?

The goal of the surgery is to align and immobilize the joint, reducing pain. In the fusion operation, the joint surfaces are removed so that the two bones will heal together. If there is no movement at the joint there will be no pain. However, the joint will be permanently stiff. People can walk fairly normally with a stiff toe as it does not hurt.

General Details of Procedure

During the procedure a metal plate and/or screws are placed in the joint. That is done so that the two bones that make up the joint, the proximal phalanx and the metatarsal, will grow together into one solid bone. When that occurs, pain is eliminated from the first MTP joint. The trade-off is that there is no motion there after the fusion. Most people can walk well in a supportive shoe and participate in many activities.

When may surgery be needed?

  • The most common reason to have this surgery is for bunion deformities, arthritis, (ie. hallux rigidus or hallux limitus) of the big toe, where the toe is already stiff and painful.
  • The need for surgery depends on how bad the bunion or arthritis is. Surgery is recommended for those with pain in the big toe joint and stiffness in the toe or persistent bunion pain.
  • A podiatric foot and ankle surgeon can determine the severity of the condition. Before deciding on surgery, patients can alter their physical activity, try different footwear, or use steroid injections.

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