1st MTPJ Fusion surgery may be recommended if you experience the following conditions:

• 1. Severe arthritis in the big toe joint causing severe pain and limitation of daily activities
• 2. Failed conservative treatments like medication, orthotics, or joint injections with steroid.
• 3. Joint deformity of the big toe.
• 4. Failed prior surgery such as bunion correction or cheilectomy

1st MTPJ Fusion surgery aims to provide the following benefits:

• 1. Reduction or elimination of pain in the big toe joint.
• 2. Increased stability and improved alignment of the foot.
• 3. Improved ability to perform activities of daily living without discomfort.
• 4. Reduction in inflammation and swelling.
• 5. Correction of deformities or abnormalities in the joint.

• 1. Anaesthesia: You will usually be given a general anaesthetic along with some injections of local anaesthetic around the nerves in the foot and ankle, to ensure you are comfortable throughout and after your surgery. The type of anaesthesia will be discussed with you prior to the procedure to ensure it is tailored to your specific medical history and operation.
• 2. Incision: An incision will be made on the inside border of the foot, along the side of the big toe joint to access the affected joint.
• 3. Joint Preparation: The damaged cartilage and any bone spurs will be removed from the joint surfaces. This will remove all the bumps from around the joint and the arthritis will also be removed.
• 4. Fusion: The surfaces of the metatarsal and phalanx bones will be prepared and joined together, usually using screws and plates, or sometimes metal staples. This positions and holds the bones together whilst your body forms bone, to fuse (bond) the joint together.
• 5. Closure: The incision will be closed with dissolving sutures under the skin and paper sutures (steristrips) along the incision, and a bandage type dressing will be applied.
• 6. Recovery: You will be moved to a recovery area to wake up from anaesthesia and be monitored by medical staff. When you are awake and after a short period of observation, you will return to the ward. After having something to drink and eat, you will soon be discharged home.

After 1st MTPJ Fusion surgery, the recovery process typically involves the following:

• 1. Immobilization: You will be given a special shoe to protect the surgical site and allow for proper healing. You will need to wear this at all times when walking and standing. It does not need to be worn at rest or at night. The shoe will protect the big toe surgery by making you walk with the weight on your heel. The shoe needs to be worn for 6 weeks after your surgery, which is the time it takes for your body to grow bone across the joint and create the fusion of the joint.
• 2. Pain Management: Medications will be prescribed to manage pain and swelling during the initial recovery phase. You should take these regularly, starting from the evening you return home and continue for the first 3-5 days at least. After this the pain will usually improve and you can reduce the painkillers as you feel things settle.
• 3. Follow-up Visits: You will be scheduled for a follow-up appointment at the nurse-led treatment room clinic at around 10-14 days after your surgery. This is to monitor your progress, remove stitches, and assess the healing process. You will also be given an appointment to see your surgeon after around 6 weeks, for a check on your progress and some x-rays to assess if the fusion has worked. You will be allowed to walk without the protective shoe from this time.
• 4. Return to Activity: The timeline for returning to regular activities and sports will vary based on individual healing and your surgeon's guidance. You will usually be able to fit the foot into wide fitting, comfortable, lace-up athletic type trainers once you come out of the shoe at around 6 weeks after the surgery. You will have some swelling in the foot for at least the first 4-6 months, so footwear will need to be comfortable and accommodating of this during this time. Return to most normal walking distances for every-day activities should be expected at around 3-4 months.

As with any surgical procedure, there are potential risks and complications involved. These are very uncommon, but may include:

• 1. Infection
• 2. Pain or swelling
• 3. Nerve damage causing tingling or numbness in the foot or toes
• 4. Delayed bone healing or non-union of the fusion causing pain
• 5. Metalwork irritation
• 6. Stiffness in the ankle or foot
• 7. Blood clot formation in the calf or lungs (Deep Vein Thrombosis / Pulmonary Embolus)
• 8. Allergic reactions to medications or anaesthesia

These risks will be discussed with you during the clinic and the pre surgery consenting process before your surgery. Please ask any questions you like and discuss any concerns you have with your surgeon before deciding to proceed with the surgery.