This procedure involves fusing (or “soldering”) the great toe joint (first MTP joint) together. The goal of surgery is to make the great joint solidly aligned and immobile. This relieves much of the pain since motion through the arthritic joint is eliminated. Great toe fusion is typically performed in patients who already have significant arthritis of the 1st MTP joint (late stage or severe hallux rigidus). It can also be successfully used, however, as a salvage procedure for patients with severe bunion deformities (hallux valgus).
To fuse the great 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 is typically fixated with two or three screws (Figure 1), although alternatively, a plate may be used to stabilize the joint.
Figure 1: Typical Great Toe fusion with screws
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 may be possible to bear some weight through the heel, provided a cast or a stiff soled boot (ex. Cam Walker) 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 failure of fixation (hardware), loss of alignment, or non-union, all of which can result in the need for further revision surgery if they occur.
Potential General Complications
Potential Specific Complications
Malposition of the joint
Malposition of the joint is a possible complication due to the difficulty the surgeon may have in determining the most appropriate position, in which the joint should be fused. Malposition of the great toe fusion is a relatively uncommon complication. However, sometimes even subtle malposition of the great toe can create symptoms because the great toe is subject to a disproportionate amount of force during walking. 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 malunion (malposition) for the 1st MTP fusion. This is because the joint itself is very small. Therefore, the area across which we are expecting bone to heal is also small. In the event that a patient is unable to successfully bridge this area with mature bone and it remains symptomatic, a revision procedure fusion with increased hardware and perhaps some bone graft can usually be effective in getting the area to heal completely.
Edited January 24, 2017