Big Toe Fusion
Big toe fusion is a surgery commonly used to treat big toe arthritis or severe bunions. It has traditionally been considered the gold standard treatment for treatment of arthritis although other techniques such as joint decompression or joint replacement, may have equally good outcomes in the right patient.
Why have the surgery?
Big toe arthritis is the commonest reason to fuse the ankle joint, but it may also be used to treat severe deformities such as bunions. It is usually offered when all non-surgical options have been exhausted.
How is surgery performed?
The operation is typically performed under a general anaesthetic. An incision is made either on top of, or at the side of the big toe. The joint surfaces are removed and the raw exposed bone is brought together and held using screws or a plate.
What are the benefits?
The operation carries a greater than 90% of resolving big toe pain in the appropriately selected patient. By improving pain, often function such as standing and walking will become easier.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Non-union, meaning that the bone does not heal and the pain continues. - Arthritis occurring in the surrounding joints, since the stiffness at the ankle joint can place extra stress on the other mobile joints and leads to them wearing out over time. - Metalwork irritation, which occurs because the skin is very thin is this area. Once the joint has fused, the metalwork can be removed, usually without concern. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
All surgeons have different protocols after surgery. Mr Patel typically keeps the toe dressed in bandages for two weeks but allows patients to bear weight fully in a rigid removable sandal for six weeks. Soft, wide-fitting shoes can then be used after this.
Any other considerations?
Many patients will think that once the joint is fused, they will not be able to move the foot. It is important to appreciate that the foot moves up and down across multiple joints so it is often not possible for an observer to see which foot has had a fusion.