What is metatarsal phalangeal joint fusion surgery?

The joints where the foot bones join the toes are called the metatarsal phalangeal (MTP) joints. They make up the middle part (ball) of your foot. In joint fusion surgery, the surgeon removes part of the toe joint and lets the toe bones grow together (fuse). The toes will not bend when you walk.

Fusion surgery may help relieve pain and swelling so you can walk more comfortably. It's done if other treatments for chronic pain and arthritis haven't worked.

First, your doctor will give you medicine to help you relax and to numb your foot. Or you may get medicine to put you to sleep.

Your surgeon will make one or more small cuts near your MTP joint. These cuts are called incisions. The doctor will remove small pieces of bone and cartilage. Then the doctor will position the bones together and join them with plates or screws that help the bones fuse. The plates or screws usually stay in your foot.

The surgery will leave scars that fade with time.

You will probably go home on the day of your surgery. If your surgery is more complex, you may spend the night in the hospital.

It may take 6 weeks or longer before swelling goes down and you have healed enough to return to your normal routine. You may be able to put weight on the foot right away, but follow your doctor's instructions. You may have some swelling and pain for up to 6 months.

Activity

• Rest when you feel tired.
• You may shower, unless your doctor tells you not to. Keep the bandage dry. If the bandage has been removed, you can wash the area with warm water and soap. Pat the area dry.
• Many people are able to return to work within several weeks after surgery.
• Allow your foot to heal. Don't move quickly or lift anything heavy until you are feeling better.
• You may need to do regular rehabilitation (rehab) exercises to strengthen your foot and improve movement. Start out slowly, and follow your doctor's instructions.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• If your bowel movements are not regular right after surgery, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.

Incision care

• You will have a dressing over the cut (incision). A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
• You may shower 24 to 48 hours after surgery. Pat the incision dry. Don't swim or take a bath for the first 2 weeks or until your doctor tells you it is okay.

Ice and elevation

• Put ice or a cold pack on your foot for 10 to 20 minutes at time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice and your skin.
• Prop up your foot and leg on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

You had surgery on your foot to remove the joint at the base of your toe. After your surgery, your foot may be red and swollen. Pain and swelling should slowly improve over the next 6 weeks. You may have some minor pain and swelling that lasts as long as 6 months to a year.

After surgery, you may need to wear a special type of shoe or boot. It will help protect your foot and keep your bones in the right position. Your doctor will remove your stitches about 2 weeks after the surgery.

Follow your doctor's instructions for putting weight on your foot. And follow any other special directions your doctor gives you.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.
• Wear clothing that's easy to put on and take off. You may have a large bandage on your foot after surgery. You may also get a special type of shoe or boot to wear.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about an hour.