Arthrodesis of the 1st MTP Joint

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You have just undergone a fusion (arthrodesis) of the joint at the base of your great toe.

The operation was performed using an incision over the joint. A special titanium plate and screws were used to hold the bones in position. At the end of the procedure, a local anaesthetic agent was infiltrated around the wound, in order to reduce post-operative pain. The wound was closed with small sutures, covered with a dressing and wrapped in a bandage. This bandage must remain in place until your first post-operative visit.

Expect some pain in your foot, particularly when the local anaesthetic wears off, but this should be controllable with elevation and oral pain-killers, and should improve dramatically over the next 48 hours.

When you are able to comfortably stand and mobilise independently, you can go home. The nursing staff will let you know when it is safe to get out of bed.

You will be fitted with a special light-weight post-operative shoe which you must wear at all times, including in bed, to protect and help splint your toe.

You may bear body weight on your foot, but you must walk in a “flat-footed” fashion and favour the elevated portion of the shoe to avoid pressure on the toe.

Occasionally, there can be some blood seepage into the dressings and cast, causing staining. This is rarely a cause for concern, unless copious.

You may shower, but it is important to keep the dressings dry. These must remain intact until your first post-operative appointment.

Keep your foot elevated as much as possible. Hip height is ideal when you are seated.

If you have any concerns regarding your progress before your first post-operative appointment, please ring the rooms, during normal hours, or your local doctor, if available after hours. If you require urgent out-of-hours attention, please ring or present to a hospital Emergency Department at any time. Both The Hills Private and Sydney Adventist Hospitals provide this service.

Continue to wear your post-operative shoe at all times, including at night, and walk in a manner that avoids ANY upward pressure on the great toe. Bending pressures on the great toe will lead to failure of the procedure, with a “non-union” and possibly the need for further surgery.

When you see Dr Newman again, at the 6-week post-operative mark, xrays will be expected to show progressing union at the fusion site and it should be possible to make the transition to conventional footwear.

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