The first metatarsophalangeal (MTP) joint, situated in the big toe, is crucial for mobility. Commonly known as hallux rigidus; when this joint develops arthritis it can lead to discomfort, swelling, and hindered movement, impacting everyday activities such as walking, running, and even shoe selection. Arthritis sets in as the protective cartilage between the bones erodes, causing friction and pain during movement.
A first MTP joint fusion emerges as a surgical solution to address big toe arthritis. This procedure aims to permanently unite the bones, eliminating the source of pain by preventing bone-on-bone contact. Consequently, it restricts motion within the big toe joint. Alternatives to this procedure include Chielectomy and Arthroplasty, although careful assessment is necessary in order to determine which is the best option for each individual patient.
Diagnosis
The decision for surgery hinges on the severity of arthritis symptoms and associated pain levels. Surgery becomes a consideration when stiffness and discomfort significantly impede daily life, such as hindering footwear choices or participation in activities. Typically, if both feet are affected, the more symptomatic foot undergoes surgery first. Evaluation by Dr. Kamel determines the extent of the condition. Before opting for surgery, non-surgical interventions like activity modifications, steroid or PRP injections may be explored. Lifestyle adjustments, such as wearing supportive footwear or utilizing carbon shoe inserts, might also be attempted.
Treatment
During the MTP joint fusion procedure, damaged cartilage is excised, and the bones are affixed together using screws and plates to facilitate fusion. This outpatient surgery allows most patients to return home the same day, unless additional monitoring is required.
Procedure Details
The surgeon accesses the big toe through an incision, removing damaged cartilage to promote bone healing. Tools may be employed to precisely shape the bones for optimal alignment. Subsequently, screws and plates are utilized to stabilize the joint, with additional screws enhancing stability and aiding in the fusion process. Post-surgery, the foot is secured with sutures and dressing.
Recovery
Following surgery, regular follow-ups monitor bone healing progress through X-rays. Weight-bearing activities are gradually reintroduced based on the surgeon's assessment. Typically patients are able to apply weight to the extremity immediately after surgery, although this may differ depending on each individual patient. Post-surgery footwear should avoid stressing the healing joint.
Risks and Considerations
As with any surgical procedure, risks include anesthesia-related complications, infection, nerve or blood vessel damage, incision healing issues, bleeding, or blood clot formation. Specific to MTP fusion, complications might involve delayed bone healing, infection, adjacent joint stiffness, or irritation caused by implanted hardware. In such cases, hardware removal might be necessary post-healing. Scarring within the joint can also impact neighboring tendons.
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