Toe Fusion Surgery

Toe fusion surgery is usually a day case procedure that is performed under a local or general anaesthetic, with an added injection during the operation to numb the foot for pain relief after surgery.

The procedure involves straightening the toe at the joint (or joints) where it’s bent. The toe is then held straight with either a thin metal wire, which protrudes slightly from the end of the toe, or a special screw/clip device inside the toe. The toe fusion operation may, in some cases, be performed along with another procedure, for example bunion surgery.

Recovery

Immediately after surgery:

• Your foot will be bandaged and numb but pain free
• You may notice some short wires visible at the end of the toe (these will be removed with a gentle painless pull in the outpatient clinic after around four weeks)
• You will be referred to a physiotherapist who can advise on a rehabilitation programme and help you to walk in a padded stiff shoe that will be supplied
• You will be sent home only when you are feeling comfortable, when you will be given an outpatient appointment and painkillers if required

During the first few weeks:

• Elevate your foot as much as possible (above the level of your heart) to reduce the 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. If you are worried, contact the Fortius Clinic
• Take painkillers as prescribed
• Avoid smoking and taking anti-inflammatory medications as this may delay or even prevent the bones from fusing together

Follow-up appointments:

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 wound will be checked and any stitches removed
• Four weeks - your foot will be X-rayed and the toe wires will be removed
• 12 weeks - follow-up appointment and discharge

When can I start to walk?

People can respond differently to surgery and your surgeon will be able to give you individual advice about when you will be able to walk and what type of what type of immobilisation device you should use (for example, a specialist hard soled shoe, a specialist boot or simply a normal shoe). Below is a guide to what may be advised:

• 0-4 weeks - you will be able to fully weight bear in a hospital shoe
• 4-6 weeks - you will be able to fully weight bear in either a hospital shoe or your own shoe (if wide enough)
• After six weeks - you will be able to fully weight bear in your own shoes

How do I wash and shower?

During the first four weeks, it’s important to keep the foot dry. However, you will be able to shower with a waterproof cover over the wound. After four weeks you can shower as normal if the wounds are healed, but gently dab them dry.

How should I look after the operation wound?

Don’t pick at your scabs, let them fall away naturally. If your wound becomes red, swollen or sore, contact the Fortius Clinic and arrange to see your consultant as soon as possible to check there is no infection.

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 in an emergency stop. Being able to do this will 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 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 two weeks; if it involves manual work, you may need to have six weeks off.

What long-term outcome can I expect after surgery?

• Good symptom relief with a straight toe once the wound heals and the toe has fused, which can take four to six weeks
• A fast return to your usual activities and sports in comfortable shoes by two to three months
• Mild swelling can continue in the toe for up to a year
• Fusion operations usually have a good outcome, with around 90% of people being happy with the results

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:

• Infection
• The risk is low (around 1%) but if there is an infection, it’s usually easily treated with antibiotics
• Nerve damage
• Nerves that supply feeling to the skin are near the operation site. Damage is rare but, if your toe stays numb after surgery, this may be because the nerve is damaged (a risk of around 5%) and it will usually recover
• Non-union
• The risk of the bones failing to fuse (join) is around 30%. If this happens, the decision about whether you need further treatment will depend on whether you continue to experience any pain and further options can be discussed with your surgeon
• 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). However, DVT is unusual after foot surgery (less than 3% risk)

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.