Big Toe MTPJ Fusion

Big toe MTPJ fusion refers to a surgical procedure that involves fusion of the metatarsophalangeal joint (MTPJ) of the big toe. The metatarsophalangeal joint is the joint connecting the metatarsal bone (the long bones in the foot) to the phalanges (the toe bones). When this joint undergoes fusion, it means that the two bones forming the joint are surgically joined together, eliminating movement at the joint.

Indications 

Big toe MTPJ fusion is typically indicated for the treatment of arthritis of the big toe (hallux rigidus). Arthritis of the big toe is characterized by the gradual loss of cartilage around the joint at the base of the big toe, causing the bone surfaces to become irregular and rub against each other, resulting in significant pain, swelling, stiffness, and reduced joint function.

Other indications for big toe MTPJ fusion surgery include:

• Deformities such as hallux valgus (bunions)
• Chronic joint instability
• Severe joint damage
• Persistent joint pain
• Failed conservative treatments

Preparation

Preparation for big toe MTPJ fusion may involve the following:

• A comprehensive medical evaluation will be conducted. This may include a review of your medical history, physical examination, and possibly blood tests or imaging studies.
• You should inform your doctor about any pre-existing medical conditions, allergies, medications, or supplements you are taking.
• Some medications, such as blood thinners, may need to be adjusted or temporarily stopped before the surgery to minimize the risk of bleeding.
• You should refrain from eating or drinking for a specified period before the surgery.
• You should arrange for someone to drive you home after the procedure
• You will be signing an informed consent form

Surgical procedure

Big toe MTPJ fusion is usually performed under general anesthesia using an ankle anesthetic block. In general, the procedure involves the following steps:

• The surgeon makes an incision over the top of the big toe joint, exposing the metatarsophalangeal joint.
• The damaged cartilage and any remaining joint surfaces are carefully removed from both the metatarsal bone and the proximal phalanx (toe bone). This step aims to eliminate or minimize painful joint movement and create a suitable surface for fusion.
• The surgeon stabilizes the joint by bringing the two bones into the desired position and securing them with special plates and screws or other fixation devices. This hardware holds the bones together during the healing process.
• In some cases, a bone graft may be used to promote bone healing and fusion. This graft can be obtained from the patient's own body (autograft) or may come from a donor (allograft).
• The incision is closed with sutures or staples, and a dressing or bandage is applied to protect the surgical site.

Postoperative care

After surgery, the foot is typically placed in a cast or special boot for a specified period to immobilize the joint and allow for proper healing. You will be given specific postoperative instructions, including information on pain management, wound care, and restrictions on weight-bearing and activities. Physical therapy may be prescribed to help with rehabilitation and to regain strength and mobility in the foot. The rehabilitation process is crucial for optimizing the functional outcome of the surgery. Appropriate footwear and mobility aids may be recommended, such as orthotic devices, crutches or a walker, in order to support the foot, facilitate movement, and aid in the healing process during recovery.

Risks and Complications

Potential risks and complications of big toe MTPJ fusion may include:

• Infection
• Joint pain/stiffness
• Hardware issues
• Non-union of bones
• Nerve damage
• Delayed healing
• Anesthesia-related risks

Summary     

Big toe MTPJ fusion surgery is usually considered when there are conditions or issues such as severe arthritis, deformities, instability, or chronic pain in the big toe that cannot be effectively managed through non-surgical means. The goal of the fusion is to alleviate pain and improve the function of the foot.