If you develop painful stiffening and thickening about the joint at the base of your big toe due to arthritis, you may be a candidate for a fusion (arthrodesis).
Whilst this operation does eliminate movement through the affected joint, it would be expected to eradicate pain and allow you to walk without a limp, at a normal pace and wearing most shoes. However, significantly high-heeled footwear would not be possible. For women who favour fashion shoes of this type, this would be the major compromise, although a 4cm heel is still possible. The fusion is permanent and does not “wear out” over time. It does not predispose to the development of arthritis in adjacent joints.
Fusion of the first MTP joint is the most common procedure for the definitive management of osteoarthritic pain and functional disturbance due to the quality of the result when compared to other operations for this problem, including total and partial joint replacements, simple bump removal (cheilectomy) and realignments (osteotomies), all of which have their inherent problems. These interventions have a much more unpredictable outcome and in the case of the replacement procedures, there is a high risk of failure and the requirement for rescue (revision) surgery.
The operation involves a removal of bumps (osteophytes) about the joint, to reduce it to a normal profile. Any remaining joint surface (articular cartilage) is removed and the underlying bone surfaces prepared, brought together and fixed in the appropriate position. Implants, including a centrally- located screw and a low-profile titanium plate, secure alignment to allow new bone to grow, effectively bridging the joint with a permanent “weld”. Once healing of the fusion is complete (consolidation), two bones are essentially now “as one”. A healed fusion is as strong as normal bone and will not fail with normal activity.
A first MTP fusion operation is usually performed as a day-surgical procedure and it allows for full weight-bearing, although wearing a post-operative shoe and with activity modification to prevent harm coming to the toe during the healing period. The shoe is worn for 6 weeks and Xrays are performed at this time to assess the quality of bone “bridging”. It takes around three months to fully recover.
As with any operation, you should consider the relative merits and weigh these against the small, relevant, attendant risks when making your decision to go ahead.
Dr Newman can provide you with more information about the operation at the time of your appointment.