MTP Replacement Surgery

You have been assessed as suitable to have to have an operation called a 1st MTP joint replacement. The implant used aims to abolish pain and gain some movement of the big toe joint.

  • Joint replacement surgery in the foot is not as well advanced as in the hip and knee.  The current implants have been used over the last five years and long-term data do not exist.  The early results are acceptable and indeed encouraging, but as with all other joint replacements, problems may occur in the future.
  • The risks of undergoing joint replacement surgery are firstly infection. There is a 1% risk, but should the joint become infected it will need to be aggressively washed out and a second operation and if infection persists the joint will need to be removed.  Dislocation of the implant is an unlikely possibility and further treatment would be required.  Nerve injury may occur resulting in altered feeling along the toe.  This is usually temporary but on occasion may persist permanently, although this is not likely to cause problems.
  • Surgery is performed under a general anaesthetic and you will stay in hospital for one night. The morning after surgery you will be allowed to mobilise in a protective heel-bearing shoe with the help of the physiotherapists.  You will not be permitted to put weight directly through the big toe joint for the first six weeks.
  • You will be seen at one week, where the wounds will be checked and the stitch ends trimmed. You will need to elevate your foot during the first week in order to minimise swelling. Once the wound has healed you will be able to mobilise more freely in the protective shoe and will start to get out and about, although driving will not be permitted.
  • At six weeks, post-operatively, you will be seen in clinic with an X-ray. This will check to see that bone is growing into the implant, and assuming it is, you will be allowed to mobilise using more normal footwear.
  • You will be shown gentle exercises to gain movement of the toe. Once the X-ray has been approved, you will be able to increase the exercises that you perform.
  • The toe joint will be stiff initially and the movements will improve over a six-month period.  The expected range of movement is not normal, although one would hope to see 30-40º of movement.
  • You will require long-term follow up of the joint replacement to ensure there are no problems.  This will consist of an annual X-ray and clinical check.
  • Further information is available on MTP replacement surgery on the following web site from the National Institute for Clinical Excellence (NICE)

Post-operative Program