1. What is a hallux fusion?
Great toe(hallux) fusion is typically performed in patients who already have significant arthritis of the 1st MTP joint (hallux rigidus). It can also be performed as a salvage procedure for patients with severe bunion deformities (hallux valgus).
This procedure involves fusing (or “soldering”) the great toe joint (first MTP joint) together. The goal of surgery is to make the great joint aligned and immobile. This relieves much of the pain since motion through the arthritic joint is eliminated. This is typically done by with screws and possible plate bridge between the metatarsal and phalange bone, but exact surgical approach is on a case by case basis.
This procedure is performed at our surgical centre. We use local anesthetic to numb the foot as well as provide conscious sedation so you are typically asleep or unaware of the procedure. General anesthetic is not required to perform this surgery. Discussions about medications and allergies can be discussed with the anesthesiologist prior to the procedure.
2. What is the recovery post- hallux fusion?
Depending upon the age and overall health status of the patient, recovery requires a period of 6 to 12 weeks to allow for adequate healing. During this time, it may be possible to bear some weight through the heel, provided a stiff soled boot (e.g. an Orthowedge) is used. The exact recovery plan will be determined by the surgeon and by the quality of the patient’s bone. Following a period of early healing (usually 6 weeks), patients are able to increase their activity level and transition to a stiff-soled shoe with a wide-toe box. Post-operative compliance with any weight-bearing and/or physiotherapy protocol is critical to avoid complications, such as failure of fixation with loosening hardware, loss of alignment, or non-union (unsuccessful bridging of mature bone across the fusion site). These complications can result in the need for revision surgery.
- Local nerve irritation: Irritation to the nerves supplying the big toe can occur as a result of this procedure. In some patients, a partially “numb” area of the big toe results from the surgery. Most nerve problems resolve in about six weeks after adequate healing.
- Wound healing: In most patients, the wound heals with no problems. In patients with medical conditions such as diabetes or inflammatory arthritis, the surgeon may give special postoperative instructions. Smoking may interfere with wound healing, and all advice regarding management of smoking should be carefully followed. In physically active patients, returning “too soon” to regular footwear, or high-intensity activity, can result in unwanted irritation of the wound, even after the wound has healed and the sutures have been removed.
- Infection: A sharp increase in pain, accompanied by redness and tenderness of the skin may indicate infection. If infection occurs it is usually related to the surface of the wound and is easily recognized and treated, usually with oral antibiotics. If a deeper infection is suspected, intravenous antibiotics may be necessary. Please contact our office immediately or seek medical attention if an infection is suspected after the procedure.
- Blood Clots (DVT): In any foot surgery, there is a small risk of developing a blood clot. Since a cheilectomy procedure allows for early mobility, the risk of blood clot is very low. If the lower leg becomes swollen and sore, this should be investigated by a physician. If you have had a blood clot in the past, or have risk factors for blood clots, advise your surgeon.
- Nonunion of the joint: unsuccessful bridging of mature bone across the fusion site. This is a complication of fusions only and not cheilectomies. Factors that can increase the patient’s risk of nonunion across the fusion site are uncontrolled diabetes mellitus, smoking, noncompliance with post surgical protocol, poor nutrition, some medications, vitamin D deficiency, and infections. In the event that a symptomatic patient is unable to successfully bridge this area of fusion with mature bone, a revision procedure may be needed. Revision of 1st MTP joint fusion commonly incorporates increased hardware for added stability and bone graft to improve biological healing at the surgical site.