A 1st MTPJ arthrodesis procedure is typically performed for hallux rigidus or a severe bunion deformity. To perform this procedure, your podiatric surgeon will first remove the articular cartilage from both sides of the joint. The big toe is then placed in the proper position and the first metatarsal head is fixated to the base of the proximal phalanx utilizing a combination of a plate and screws. This type of fixation often allows for earlier weight-bearing and quicker recovery.
What to expect with your surgery
The day of the surgery
On the day of the surgery, your podiatric surgeon will visit with you and answer any additional questions you may have. You will also meet with the anesthesiologist to discuss what type of anesthesia you will have for the surgery. A nurse will typically start an IV so the anesthesiologist can administer any necessary medication during the procedure. If this is the only procedure being done on your foot, the surgery takes approximately 1 hour. Your doctor will numb your foot after the surgery and will give you a prescription for pain medication. You will also be given detailed instructions on how to care for your foot.
Most of the pain and inflammation from the surgery will be during week 1. Your doctor will place you into a surgical boot following the surgery. You should always wear this boot when up walking. You may remove this during times when you are sitting. You should elevate and rest your foot as much as possible. You will leave your bandages on your foot and you should not get your foot wet. When you return to the office for your first appointment, your doctor will take x-rays and change the dressing. Sutures are not typically taken out at this point.
There is usually less pain and inflammation during this week. You will wear your surgical boot and keep your foot dry. Activity may generally be increased slightly depending on how much inflammation is present. At the second week appointment, your doctor will usually take out your sutures. You may be able to get the foot wet at this point.
You will continue to wear the surgical boot during this time. You doctor may fit you with an ace wrap to help control swelling.
Your doctor will usually take an x-ray at this time to ensure that the bone is healing normally. Bone healing will continue throughout the next month.
Your doctor will likely take another x-ray to assess bone healing. If enough healing has occurred and there is minimal swelling, you may be able to start walking with a lace-up shoe and increase your activity level slightly.
Week 8 and beyond
Most of the bone healing is usually done at week 8. Your body will continue to “remodel” the bone where the arthrodesis was performed. Although the majority of patients may begin to get back to their regular activities at this point, some may have swelling and/or pain that may persist longer. Activity should be increased as tolerated.