Understanding 1st MTP Joint Fusion with Locking Plate: A Guide for Patients

Hallux rigidus, or arthritis of the big toe joint, can cause significant pain, discomfort, and difficulty with mobility. The 1st MTP (metatarsophalangeal) joint fusion with a locking plate is a definitive surgical solution designed to reduce pain, improve alignment, and restore function. This article provides an overview of the procedure, its benefits, and the recovery process.

X-ray of a foot with metal screws and plate for surgical fixation, alongside a close-up of a similar metal plate with screws.

What is 1st MTP Joint Fusion with Locking Plate?

This procedure involves fusing the 1st MTP joint by removing the damaged cartilage and securing the bones in a corrected alignment using screws and a locking plate. The fusion eliminates movement in the joint, thereby reducing pain and improving toe alignment.

The surgery typically takes between 45 and 60 minutes and does not usually require a plaster cast, thanks to the stability provided by the locking plate.

Why Consider This Surgery?

The primary aims of 1st MTP joint fusion are:

To reduce pain caused by arthritis or instability in the joint.
To correct deformities and improve alignment of the big toe.
To provide a more predictable and long-lasting solution compared to other procedures.

Advantages:

Reduces pain effectively by eliminating movement in the joint.
A definitive solution with a high success rate.

Risks and Considerations

As with any surgical procedure, there are specific risks, including:

Pressure lesions on the big toe.
Arthritis in smaller joints of the big toe.
Poor alignment.
Non-union (failure of the bone to heal together).
Problems with fixation (e.g., screws, plates, or pins).
Transfer of pressure to the ball of the foot.

Your consultant will discuss these risks with you and explain the measures taken to minimise complications.

Who is a Candidate for This Procedure?

This surgery is recommended for individuals with:

Unstable or arthritic 1st MTP joints.
Difficulty finding comfortable footwear despite wearing sensible shoes.
Failure to respond to alternative treatments.

Alternative Treatments:

Modifying activity levels.
Using painkillers and anti-inflammatory medications.
Wearing rocker-soled or extra-depth/width shoes.
Orthotic foot supports or joint injection therapy.
Other surgical options, such as excisional arthroplasty or joint implants.

What to Expect During Surgery

The procedure is typically performed under a local anaesthetic block, ensuring you remain awake but pain-free. Sedation or general anaesthesia may also be an option if preferred. Following the operation, you will spend time in the day surgery unit for observation before heading home.

It is essential to have a responsible adult accompany you and assist you during the first 24 hours post-surgery.

Recovery Timeline

First 2-4 Days:

Pain is most intense during this period, but prescribed painkillers will help manage discomfort.
Rest is essential. Keep your foot elevated and minimise walking.
Use crutches as instructed to avoid putting weight on the operated foot.

Two Weeks After Surgery:

Attend a follow-up appointment for progress checks and suture removal if necessary.
If you have a plaster cast, it may be replaced for an additional 2-6 weeks.

4-8 Weeks After Surgery:

X-rays will be taken to assess bone healing.
If fusion is successful, you can begin wearing trainer-style shoes and gradually increase walking.
Swelling and mild discomfort are common but should improve.
Non-manual work can typically resume at this stage, while manual jobs may require additional time.
Driving may resume if you can safely perform an emergency stop (check with your insurer).

8-12 Weeks After Surgery:

The foot will continue to heal, with reduced swelling.
Sporting activities may be reintroduced after three months, depending on recovery progress.

Six Months After Surgery:

A final review will evaluate long-term recovery.
Swelling should be minimal, and you should experience the full benefits of the procedure.

Twelve Months After Surgery:

Full healing is achieved, and any remaining improvements will stabilise.

Planning for Recovery

To ensure a smooth recovery:

Arrange for assistance with daily tasks during the initial weeks post-surgery.
Follow all post-operative care instructions provided by your consultant.
Attend all scheduled follow-up appointments to monitor progress.

1st MTP joint fusion with a locking plate is a highly effective procedure for addressing hallux rigidus and related issues. By adhering to post-operative care guidelines and maintaining regular follow-ups, most patients achieve significant improvements in mobility and quality of life. If you are considering this procedure, consult your healthcare provider to determine if it is the right option for you.