FUSION OF THE FIRST METATARSOPHALANGEAL JOINT

Method: Fusion of the first metatarsophalangeal joint to treat severe osteoarthritis

Duration: 45 to 60 minutes

Recovery time: 6 to 12 weeks

What is a fusion of the first metatarsophalangeal joint?

Arthrodesis (fusion) of the first metatarsophalangeal joint is a well-established procedure for treating advanced osteoarthritis (hallux rigidus) when joint-preserving measures such as a cheilectomy or implants are no longer sufficient. The aim is lasting freedom from pain and a stable roll-off when walking that can take the load.

How the operation proceeds

Incision over the first metatarsophalangeal joint, exposure of the joint
Removal of the destroyed cartilage, preparation of the joint surfaces with a burr
Setting the big toe precisely in a functional position (slight dorsiflexion)
Fixation with a locking plate, screws or special implants
Closure of the wound, dressing and fitting of a post-operative shoe

Rehabilitation after a fusion

Aftercare following a fusion of the first metatarsophalangeal joint requires patience, as the bone takes several weeks to heal. The aim is stable bony union without any remaining symptoms.

Phase I (0-6 weeks): immobilisation and unloading

Wearing a forefoot offloading shoe throughout
Elevation of the foot to reduce swelling
No loading of the ball of the big toe
Wound checks and removal of sutures after 2 weeks where needed

Phase II (7-12 weeks): increasing load

Changing to a comfortable off-the-shelf shoe once medically cleared
Building up a symmetrical gait pattern with physiotherapy
Strengthening the surrounding muscles
Regular X-ray checks to confirm bony union

Phase III (from 3 months): return to everyday loading

Full weight-bearing in everyday life in stable, well-cushioned footwear
Sports such as cycling or swimming are usually possible without difficulty
Follow-up appointments to assess progress
No more pain during roll-off – the aim of the treatment