Big toe fusion surgery

What is big toe fusion surgery?

Big toe fusion surgery, also known as arthrodesis or first MTP joint fusion, permanently joins the bones of the big toe joint so they no longer move against each other. This removes the painful grinding caused by arthritis and creates a stable, well-aligned toe that can bear weight more comfortably.

What conditions can big toe fusion surgery treat?

Big toe fusion surgery may be recommended for patients with:

• Hallux rigidus
• Rheumatoid arthritis
• Severe joint damage after injury
• Long-standing deformity
• Persistent pain that limits walking.

What is hallux rigidus?

Hallux rigidus is arthritis of the big toe (hallux) joint. Over time, the cartilage that cushions the joint wears away, causing the bones to rub together. This leads to stiffness, swelling and pain, especially when walking or bending the toe. Some people develop a bony bump on top of the joint, making shoes uncomfortable to wear.

What causes hallux rigidus?

Hallux rigidus can develop after an injury, from long-term wear and tear, or as part of an inflammatory condition such as rheumatoid arthritis or gout.

What are the symptoms of hallux ridigus?

Symptoms can include:

• Pain at the base of the big toe
• Stiffness
• Swelling
• Difficulty bending the toe
• Discomfort when walking or wearing certain shoes.

Who is at risk of developing hallux rigidus?

You may be more at risk of developing hallux rigidus if you have:

• A family history of foot arthritis
• Had previous toe injuries
• Taken part in high-impact activities
• Inflammatory conditions such as rheumatoid arthritis.

How serious is hallux rigidus if left untreated?

Without treatment, the big toe joint can become increasingly stiff and painful. Walking may become difficult, and the deformity can worsen over time.

How does rheumatoid arthritis affect the big toe?

Rheumatoid arthritis can damage the lining of the joint, causing swelling, deformity and progressive stiffness. Big toe fusion is often recommended when rheumatoid arthritis causes severe joint destruction.

How do I know if I need big toe fusion surgery?

You may be recommended surgery if pain affects your daily activities, your big toe is stiff or it’s difficult to bend, when traditional treatments no longer help, or X-rays show severe arthritis.

Many patients choose surgery when walking, standing or wearing shoes becomes increasingly difficult.

Who is suitable for big toe fusion surgery?

You may be suitable if you have:

• Severe arthritis of the big toe
• Persistent pain despite non-surgical treatment
• Good general health.

Big toe fusion surgery eliminates movement in the joint, so it’s important to understand how this may affect footwear choices.

Who is not suitable for big toe fusion surgery?

You may not be suitable for big toe fusion if you have:

• Poor circulation
• Uncontrolled diabetes
• Active infection
• Smoke heavily – smoking significantly increases the risk of the bones failing to fuse (also known as nonunion).

What are the alternatives to big toe fusion surgery?

Non-surgical alternatives include:

• Wider footwear
• Orthotics
• Adjustments to certain activities
• Anti-inflammatory medication
• Steroid injections.

For early-stage arthritis, a cheilectomy – removing bone spurs to improve movement – may help.

How can I prepare for big toe fusion surgery?

Your surgeon or healthcare team may advise you to:

• Stop smoking at least 4 weeks before surgery
• Maintain a healthy weight
• Stay active
• Arrange for someone to drive you home and help you at home
• You can reduce your risk of infection by showering before your operation, keeping warm on the day and managing blood sugar levels if you have diabetes.

Please tell your surgeon and pre-assessment nurse about all the medications you are taking, including prescription medications, over-the-counter drugs, and supplements. They will advise you on whether to continue or temporarily stop taking medicines before and after your surgery.

What happens at my big toe fusion pre-operative assessment?

You’ll meet a member of the healthcare team to review your medical history, current medications, and any previous experiences with anaesthesia. They will discuss anaesthetic options, assess your fitness for surgery, and help plan your recovery.

You may need blood tests or other investigations, depending on your health and the type of anaesthetic being used. You’ll also be given advice on preparing for surgery, including fasting instructions, managing your medications, and what to expect after the operation.

What happens during big toe fusion surgery?

Big toe fusion surgery is usually performed under general anaesthesia and takes around 30 to 60 minutes.

During surgery, your surgeon will:

1. Make a single incision (cut) along the top of your big toe to reach the joint. The incision is usually 3 to 5cm long. A nerve block is also injected around the ankle to keep your foot numb for a few hours after surgery.
2. Remove any remaining damaged cartilage and any bony lumps (sometimes called bone spurs or osteophytes) from around the joint, exposing fresh, healthy bone on both sides - this is what allows the bones to knit together.
3. Position your toe at a slight upward angle so you can push off comfortably when you walk, then fix the bones firmly in place using a small metal plate, screws, or bone staples.
4. The wound is closed with stitches, and your foot is wrapped in a firm dressing.

How long does it take to recover after big toe fusion surgery?

Some patients can go home on the same day, while others may stay 1 night in the hospital. Your toe will be stiff, swollen and sore initially. Be sure to take pain relief regularly to help manage your pain symptoms.

A physiotherapist will help you begin moving safely using crutches. You’ll be given a special post-operative shoe to wear for 6 weeks, allowing you to put weight on your heel while protecting the fusion.

Your dressing will be checked after a few days, and you’ll return to the hospital at 10 to 14 days to have your stitches removed. An X-ray at 6 weeks will assess whether the bones are fusing correctly.

Swelling of the big toe can take several months to settle, and you may need to wear flat shoes long-term, as the toe will no longer bend.

Returning to activities

• Walking: Immediately after surgery, you will be advised to have someone to support you with walking and to use crutches. You can resume normal walking once the fusion of the big toe is confirmed.
• Driving: Usually after 6 weeks - please check with your car insurance provider.
• Work: You can resume desk work after 2 to 4 weeks. If your job involves manual work, this may take longer. Your surgeon will advise when you can return to work.
• Exercise: You can do light exercise after 3 to 6 months.
• Sport: You can gradually return to sport once your big toe has fully healed.

What are the risks and complications of big toe fusion surgery?

Every surgical procedure has a risk of complications. However, your surgeon will ensure these are minimised.

General risks include:

• Pain
• Bleeding
• Infection
• Blood clots (deep vein thrombosis)

Specific complications of toe fusion:

• Swelling
• Continued pain
• Nerve damage
• Scarring
• Failure of the bones to fuse (nonunion).

What is the success rate?

Big toe fusion has a high success rate, with most patients (around 80-90%) experiencing long-term satisfaction¹.

How much does big toe fusion surgery cost at Nuffield Health?

For pricing information, please contact your local hospital. The hospital or your healthcare team will give you a fixed all-inclusive price for the treatment following your initial consultation.

Sources:
1. https://www.eoc.nhs.uk/treatments/big-toe-fusion/