Big Toe Fusion
This procedure involves fusing (or “soldering”) the big toe joint (first MTP joint) together. The goal of surgery is to make the joint solidly aligned and immobile. This relieves much of the pain since motion through the arthritic joint is eliminated.Big toe fusion is typically performed in patients who already have significant arthritis of the 1st MTP joint (hallux rigidus). It can also be performed as a salvage procedure for patients with severe bunion deformities (hallux valgus).
To fuse the toe joint, any remnant cartilage on the arthritic joint surface is removed and the underlying bone is prepared for fusion. The joint is positioned in a manner which maximizes walking ability and maintains acceptable clinical alignment. This is traditionally done with the toe positioned so that it just gently touches the ground in a weight bearing position. The fused joint can be fixated with a plate to stabilize the joint.
Depending upon the age and overall health status of the patient, recovery requires a period of 6 to 12 weeks to allow for adequate healing. During this time, it is possible to bear some weight through the heel, provided a stiff soled shoe is used. The exact recovery plan will be determined by the surgeon and by the quality of the patient’s bone. Following a period of early healing (usually 6 weeks), patients are able to increase their activity level and transition to a stiff-soled shoe with a wide-toe box. Post-operative compliance with any weight-bearing and/or physiotherapy protocol is critical to avoid complications, such as failure of fixation with loosening hardware, loss of alignment, or non-union (unsuccessful bridging of mature bone across the fusion or fracture site). These complications can result in the need for revision surgery.
Potential General Complications
- Wound Healing Problems
- Local nerve injury
Potential Specific Complications
Malposition of the joint (Mal-union)
Malposition of the joint is a possible complication due to the difficulty the surgeon may have in determining the most appropriate position to fuse the joint. Malposition of the great toe fusion is a relatively uncommon complication. In the rare cases that this occurs, it can often be rectified by repositioning the toe with further surgery.
Nonunion of the joint
Nonunion is probably more common than mal-union for 1st MTP joint fusion. Factors that can increase the patients’ risk of nonunion across the fusion site are controlled diabetes mellitus, smoking, and noncompliance with post surgical protocol, poor nutrition, medications, vitamin D deficiency, infections, and hormonal irregularity. In the event that a symptomatic patient is unable to successfully bridge this area of fusion with mature bone, a revision procedure may be needed. Revision of 1st MTP joint fusion commonly incorporates increased hardware for added stability and bone graft to improve biological healing at the surgical site.