Procedure
First MTP Joint Fusion
For First MTP Joint Osteoarthritis
What It Involves
A first MTP joint fusion (arthrodesis) permanently joins the big toe bone to the metatarsal, eliminating movement at the arthritic joint and thereby eliminating the pain arising from it. The joint surfaces are prepared and the bones are held in a carefully selected position using a plate and screws, or screws alone, while they fuse together. Once healed, the fusion is permanent and very durable.
The toe is fused in a single, carefully selected position for comfortable flat-ground walking and stair use — because the joint is fixed rather than moving, this is inevitably a compromise across all footwear and activities. High heels are not possible afterwards, but a small heel can usually be accommodated. The operation typically takes 60–90 minutes, and the vast majority of patients walk comfortably and naturally afterwards.
Recovery Timeline
Everyone heals at a different rate — this timeline is a guide.
Weeks 1–2
Full weight-bearing in a surgical sandal from the outset, with the foot elevated as much as possible. The wound is checked and sutures removed at 2 weeks.
Weeks 2–6
Continuing in the surgical sandal as swelling gradually settles, ahead of the 6-week X-ray which checks fusion progress.
Weeks 6–12
If the X-ray is satisfactory, transition into stiff-soled, comfortable footwear — a rocker-soled style compensates well for the loss of toe motion. Graduated return to normal activity and gait/lower limb strengthening follows. Roles involving prolonged standing or walking typically need around 6 weeks off.
3 months
Most patients are walking comfortably in normal shoes and have returned to their full range of activities, including sport, with a final review and discharge once fusion is confirmed.