Introduction
Osteoarthrosis of the big toe MTP joint can cause painful stiffness of the big toe and make walking difficult.
Indications
Although there is a replacement prosthesis developed for this joint, it is not reliable and is rarely recommended. When the pain and stiffness of the arthritis are limiting your capacity to walk comfortably, it can be reliably helped with an operation. The best operation is fusion of the MTP joint.
Preoperative Instructions
No specific pre-operative planning is required for this. It may be helpful to be able to use crutches but you do not necessarily need crutches to mobilise after this surgery.
Procedure
The joint is approached on the dorsum of your big toe. The deformed areas of bone are removed to restore the normal contour of the bones. After preparation of the joint surfaces they are compressed together and fixed with a plate and screws in the correct position and ensures reliable and rapid healing of the fusion. An external splint is not required as the fixation is adequate to hold the toe but you are advised not to take weight on the big toe until instructed that it is safe to do so.
Postoperative Instructions
You can use crutches if walking unaided is difficult. When the wound has healed, you will not require a dressing or splint. An x-ray at six weeks is taken to confirm the bones have healed solidly after which you can take full weight on it and this encourages recovery of the bone strength. The correction is permanent.
Risks
There are always some risks with any operation. The problems that may rarely arise after this surgery are blood clots, wound infection or perhaps a failure of the bone to unite before the plate breaks. All these problems are exceedingly rare.
Treatment alternatives
By the time you have been advised to have surgery, you will have tried splints, orthotics and passive stretches. These deformities do not respond to these therapies and the only way of establishing normal alignment in a permanent way is by surgery.