Joint fusion surgery of the big toe is carried out to treat big toe arthritis (hallux rigidus).
What does it involve?
It is normally carried out as a day case procedure under a general anaesthetic, along with an injection in the foot so that it’s pain-free after surgery.
During the procedure the surgeon makes an incision (cut) on top of the big toe, removes the damaged joint and bone, and then attaches the metatarsal bone to the phalanx bone with a screw and plate.
Immediately after surgery:
- Your foot will be bandaged, numb and pain free
- Your specialist will refer you to a physiotherapist to advise on exercises and walking in the padded stiff shoe supplied
- You will be sent home only when you are comfortable, with a follow-up appointment and painkillers if required
During the first few weeks:
- Elevate your foot (raise it above your heart) as much as possible to reduce swelling
- Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
- Some blood ooze can be expected in the bandage; however, if you are worried, contact the Fortius Clinic for advice
- Take painkillers as prescribed
- Avoid smoking and taking anti-inflammatory medications as this may delay or even prevent the bones from fusing together
Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:
- Two weeks - your bandage will be removed
- Six weeks - your hospital shoe will be removed (after which you can wear your own shoes) and you will have a follow-up X-ray
- 12 weeks - final appointment, X-ray and discharge
When can I start to walk?
People can respond differently to the surgery, with some being able to walk more easily than others, especially in the early stages post-operatively. Below is a guide to what may be advised:
- 0-6 weeks - you will be able to fully weight bear in a hospital shoe
- After six weeks - you will be able to fully weight bear in your own shoes
How do I wash and shower?
During the first two weeks it’s important to keep the bandaging totally dry, although you can still shower using a waterproof cover over the foot. After two weeks you can remove the cover if the wound is healed, but gently dab the wound dry.
How should I look after the wound?
Once out of the bandaging, don’t pull at your scabs but let them fall away naturally. If your wound becomes red, swollen or sore, contact the Fortius Clinic and arrange to see your consultant to check it’s not infected.
Physiotherapy and rehabilitation
Your specialist will be able to refer you to a physiotherapist who will give you a personalised rehabilitation programme to help you to walk normally, and to reduce swelling and tightness in the muscles.
When can I start to drive again?
The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car during an emergency stop. This will normally take at least six weeks.
Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.
When can I return to work?
This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time, you should be able to return to work after four weeks; if it involves manual work, you may need to have up to eight weeks off.
What long-term outcome can I expect after surgery?
- You should notice an improvement in pain quite soon after the procedure and this should continue until the bones have fused (at around three months after surgery)
- Most people are able to return to a good level of activity and sports within six months, with continued improvement for up to a year
- In 90% of people the operation is very successful although you may have mild swelling in your ankle for up to a year after the procedure
What are the risks?
Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:
- The chance of infection is around 1% and can usually be treated with antibiotics. Serious problems caused by infection are very rare and can be treated
- Nerve damage
- Small nerves that supply feeling to the skin near the operation site can be damaged, although the risk is very small (around 5%). If your toe stays numb after surgery, this may be because the nerve is bruised but it will usually recover
- This means the bones fail to join together as they heal and the risk is around 5-10%. Although non-union can be painless, in which case it may not need treatment, in some cases you may need further surgery
- Prominent metalwork
- Sometimes the metal used to fuse the joint can be prominent. However, once the bones have fused (usually after around six months) the metal can easily be removed during a minor day case procedure
- Deep Vein Thrombosis (DVT)
- You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). The risk of DVT after this type of procedure is, however, less than 3% and may be reduced if you keep your ankle moving and carry out the recommended exercises
Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery