Big toe fusion operation

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    Matt C

    Hello from a newbie.

    I’m writing this in the hope that someone will gain something from it. If you’re reading it, then you may be unfortunate enough to be in the same boat. When I was considering what to do for the pain in my feet, I read whatever I could find. Much of it was contradictory or irrelevant, but rather than just listen to a doctor I wanted to be properly informed. Each person’s story is bound to be different. This is mine. It’s by no means a medically informed discussion, merely a record of what it was like. Good luck with your particular journey.

    About me –
    I’m a 59 Year old male, fit and active, 6 feet tall, 94Kg (15 Stone) heavy set (alright, slightly overweight) and living on the south coast of the UK.

    I’ve had problems with osteoarthritis since the age of 28. It’s not been anything serious, just aches and pains that you wouldn’t expect at that age. My job was quite physical and eventually became too much, so at the age of 45 I swapped it for something more gentle. I was managing ok and had had only had a shoulder op to relieve pain, but by the age of 50, my big toes had become seriously painful. I took to wearing rocker soled MBT shoes or mountain boots which helped enormously. In 2011, my feet seemed to have had enough and rapidly went downhill. I had blamed an old motorcycle injury to my left big toe up until then, but now both big toes were painful enough to stop me walking far or doing anything active. Ski boots, motorcycle boots and all but sandals were too painful to wear and I looked upon footwear as instruments of torture.

    After my GP messed me around prescribing a kind of warming embrocation (plonker), I eventually had hydrocortisone injections with ‘manipulation under anaesthetic’. This was a very quick, simple operation and worked like magic giving real relief from pain, but after 7 weeks all was back to normal. Having read that a person shouldn’t have Hc injections more than two-three times, I sought other help.

    A local surgeon suggested that the joints were too far gone for a cheilectomy (basically a bit of a tidy up) to be of use, and offered MTP fusion. Having read about it, I realised that it wasn’t an easy option and that I’d need to set aside 6 months for each operation to heal. At this point I was in constant pain and went ahead with a right 1st MTP fusion on April 22nd 2015.

    The results were mixed; the pain in the joint has gone as there is now no joint, but there is pain in the end joint of the big toe due to added stress on it, but only when walking quickly. I decided that it was worth going ahead with a fusion of the left big toe, and am sitting here now with that foot bandaged and screwed together.

    The recovery from the operation is so slow and depends so much on how it’s approached that I wish that I’d kept a diary last time. This time I will, and it begins here. I hope that it is of some help.

    Day 1
    Into hospital at 8am, out at 1pm. The surgeon used two crossed pins (screws?) in my right foot, but on request he offered to use a titanium plate and screws as I’m due to have an MRI in 4 days (that’s another story). Steel parts in fresh wounds and powerful magnetic fields aren’t a good marriage and titanium is unaffected by magnets.

    I was given 1 gram Paracetamol and 800mg Ibuprofen before the op as well as an ankle nerve block. When I asked about the general anaesthetic, I was told that it was a mix of Harold Shipman and Michael Jackson’s drugs of choice. That was reassuring.

    After an interesting combination of orange squash, toast and two doses of oral morphine I was sent home on crutches and a stiff soled sandal feeling absolutely fine. General wisdom is that it’s vital to keep the foot elevated as much as possible for the first couple of weeks, so my ever loving plonked me on the couch with a large cushion under the foot. The large cushion was actually a rolled up quilt which was to be my companion for a week or so.

    I decided not to use the morphine that I’d been sent home with, but instead took Paracetamol and Ibuprofen together. I find that morphine and codeine tend to stop one of the body’s basic functions. That’s really not a good thing. Sleep came easily with a raised bed end and frame over the foot, helped with a top up of drugs in the night. Life was revolving around 4-hourly cycles of pain relief.

    Days 2-4
    Apart from boredom at sitting with an elevated foot, all is OK. The pain comes and goes. Lowering the foot hurts as the blood rushes to it and it takes time to settle after sitting again. By night 3, I was without any painkillers and hopefully can kiss them goodbye. What’s the pain like? It’s how I imagine it would feel to have had my foot run over by a fork lift truck or squeezed in a vice.

    Our 2 cats have decided that I’m a reliable source of warmth and company and are normally to be found curled up on me.

    Day 5
    I have an outpatient’s appointment to check the dressings etc. I can sit in the back of the car with my foot up then keep my foot up in the waiting room. I’m determined that it will be a trouble free recovery. A non-union would be a disaster and the thought of further operations keeps me behaving sensibly.

    The appointment was short and sweet. The bandages were cut off, leaving just tape on the wound. New bandages were put on and I was back out, to come back in a week to have all dressings removed.

    Week 2
    Having had occasional Paracetamol to sleep at night, I’m now off painkillers completely which is a relief. The foot is comfortable unless I try standing on it, when it gives me an aching kind of sensation. I guess it’s a good reminder that bones are trying to knit and shouldn’t be stressed in any way. I overdid it during the week and spent several days afterwards with an aching arch. I’d done nothing untoward, just a short walk around the local harbour using crutches and gently dabbing the left foot down. I try hard not to twist my foot but find it’s instinctive to walk on the outside edge.

    I found the same thing when my right foot was operated on; such invasive surgery and hobbling strangely will bring on unexpected aches and pains. Using crutches is a good example. Just going from room to room or up and down stairs is exhausting. A lot of MTP fusion patients will also have arthritis elsewhere, increasing the chance of pain in other joints through overwork. My hands, elbows, knee and shoulders are suffering at the moment.

    My second OP appointment went well. Taking off the dressings brought me out in a cold sweat as they’d stuck but the nurse was very gentle. There’s just a small dressing on now that I’ll take off in a few days. The next appointment is with the surgeon at 6 weeks for x-ray and check-up.

    It’s good to be sleeping without the end of the bed raised and without a frame over my feet, although the pressure of the quilt is still too much so I just have a sheet over my feet.

    Now that it’s not so important to elevate my foot, I have a feeling that boredom will kick in and the temptation to get up and do something silly will be too much. I have a stack of things that need doing like servicing lawnmowers and chainsaws, taking a tree down etc., and sitting around has given me too many ideas of things to make. I must behave but it’s so damned frustrating.

    More to follow. M x


    Jan Sadler

    Hi Matt,
    Many thanks for your post. Don’t give in to the boredom, gently does it. 🙂
    Wishing you all the best for a full recovery.
    Jan at PainSupport.



    Hi Matt,

    Welcome to this wonderful site.

    I’m very interested to read about your big toe fusion operation and recovery as I was supposed to have this operation in 2010 when the pain in both feet was diagnosed as OA as a result of having bunions removed at the age of 10.

    I saw the xrays which showed a lot of grey which is the arthritis, the surgeon told me I was walking on bone on bone. I didn’t have the foot op in 2010 as I was still recovering from spinal surgery. Strangely enough though I have had only a few short-lasting bouts of arthritic pain in my feet since then. Having been made far worse in pain terms since my back operations (3) I’m so pleased I didn’t do anything about my feet. I know it will probably catch me out one day soon but for now I’ll just keep everything crossed.

    I do hope your recovery goes well, I will watch out for further instalments!

    Take care and don’t forget the golden rule about pacing yourself.



    Hi Matt, I experience continual pain from my right toe, been offered fusion but still haven’t gone there, l tend to walk bit like , well, stiff legged with one foot, never walk on uneven ground, seem to live in steel toe cap boots, the joint is starting to fuse itself, hurts in the padded area underneath as well. If , well I guess you can no longer bend that knuckle joint, if that’s the case with both feet would you be walking in a shuffling way, or somehow kicking out with both feet, I mean I do as much as possible to avoid bending that joint, that’s how I get by, but if I had to walk like that with both feet I’m not sure how I’d get on, how will the way you walk be affected in the future, barry


    Matt C

    Thank you both for the kind words.
    As I said, everyone is different, and I know of someone who lives pain free with zero movement in their MTP joints, yet it brings others to their knees.
    Three of my four children have had 4 back operations between them so I can sympathise, Laura.
    Having time on my hands, I’m reading a bit and am currently reading ‘The Rough Guide to Happiness’. It’s highly recommended Positive thinking can work wonders.
    I wish you both well.



    Incidentally, before these operations came along were you advised to, or did you wear any orthotics, especially bespoke ones, I wear a standard pair from a local shop, I did spend several hundred pounds on having ones made up, then the NHS made up several, just couldn’t wear them , they were too hard, upset the plantar fascia both feet, also my knees, lower back etc.., but these local bought ones are softer, just take the pressure of my toe, stops my foot rolling inwards as I walk, relieves a lot of discomfort.


    Matt C

    Hi Barry,
    I’m sorry to hear about your troubles. It all sounds very familiar.

    With the one fused big toe MTP joint I had no problem at all in walking. If anything, I’d say that it was easier than before having it fused, as the pain and fear is gone. I wear rocker soled shoes and would recommend them after a fusion.

    I would never give advise, but simply say that I found myself last year completely immersed in a world of pain and wasn’t thinking clearly. I took a step back and had a good long look at my life and the options available to improve it. Looking back, I’m very glad that I did.

    A big toe fusion is not something to take lightly and apart from the various risks and possibility of other joints giving in due to the extra stress, you need to put your life aside for at least 6 months.

    Over the years I’ve tried stiff soled shoes (mountaineering boots are good) that successfully stop the toe from bending, rocker soled shoes like MBT and Sketcher Shape-Ups and various insoles. It was the aching of the joint 24/7 that finally pushed me towards a fusion. That and the shock of 7 blissful weeks pain free after an Hc injection with manipulation.
    I wish you all the best.



    Hi Matt. Thankyou for your honest and informative post. I have awful trouble with my feet too. overpronation, botched bunion surgery and have been advised now that fusion is the only option left. Having said that ,over the summer I have managed to walk reasonably well. Previously I could not due to aching joint,burning nerve pain etc. I have been to Wrightington hospital where I met a marvellous consultant who has advised me to manage if I can ie there is no rush to have surgery. I am very reluctant to have surgery having had a very bad year last year with severe nerve pain. Presently I am managing to wean myself off a very high dose of pregabalin . I know what it’s like to have painful feet and wish you a speedy (well as speedy as possible) recovery. Kate


    Matt C

    Thank you Kate for the good wishes, and I hope that things improve for you very soon.
    Such problems never seem to be clear cut, and a bit like computer programming; you fix a problem in one area and it causes other unforseeable problems. As they say in Spain: ‘poco a poco’ (little by little).

    I feel humbled and a bit of a fraud when reading of other’s problems here on the forum, and it makes me determined to do more voluntary work once I’m on my feet.

    Best wishes,


    Matt C

    It’s been a while since the last post (cue the trumpet player) as I wanted to put down my thoughts when I felt things had settled down. That was maybe a lttle naive as bodies change constantly. Anyhow, these are my final thoughts having been through 1st MTP fusions on both feet. This isn’t based on medical knowledge but is just my experience and everyone will have a different journey. Caveat emptor!

    I had MTP fusions on the right and left big toes 22 and 16 months ago respectively.
    Has it been successful? In a word, partly.

    The good side –
    The pain in the joints has gone completely as there are no joints. A malunion where the joint doesn’t fuse is possible but I was lucky – and careful.
    I’m back to wearing shoes, walking boots and motorcycle boots.
    I can walk distances with little problem.
    There’s no constant nagging pain to keep me awake.

    The flip side –
    There is some pain in the adjacent toes where weight is transferred onto them, but it’s entirely bearable.
    The right toe was repositioned too low and close to the neighbouring toe, causing it to rub when walking. A sticky plaster cures the problem.
    The left toe was repositioned too high and sticking out like a hitch hiker’s thumb (not quite, but you get the picture). It made it impossible to fit ordinary shoes, and still does. It’s also prone to being bashed to the extent that I recently broke the bone at the end of the toe. That was seriously painful. The surgeon offered to re-operate, warning that he may need to make a bone graft from my leg. After researching and finding extra wide fitting shoes and boots, I declined the operation and now at 16 months post op, a little bit of pressure on my feet isn’t a problem.
    Both toes seem to be moving around and changing shape. I would have laughed had someone said that to me a couple years ago but it’s true. Who knows what shape they’ll be in the future but my modelling days are over.

    So, a mixture of good and not so good, but a world away from the constant pain of 2 years ago. Knowing what I know now, I’d definitely have the operations done, but maybe find out beforehand about the success rate of the surgeon.

    Good luck with your journey, and remember – you are what you eat, so eat well.




    Hi Matt,

    It’s good to hear your thoughts about your operations… you tell me so much stuff that the doctor wouldn’t say so it’s very valuable to me.

    I’m almost 7 years on from being diagnosed as having OA in both big toe joints but I’m still not having the ops until I’m desperate and that’s not yet hopefully.

    Thanks so much for the update, it’s very useful to those of us in a similar boat.



    Hi Matt, I don’t have problems with my feet, but my aunt does with rhumatoid athritis, poor woman, has had both her little toes removed.but they wont remove anything more and has fusion done on 2 of her other toes, so to watch her and the troubles she has had, i can visualise what you have gone through.she has trouble, but says at least I’m not in excruciating pain like i was and wished she could have all her toes removed and says i know i wont be able to walk but least i’ll be pain free,and has even asked the surgeon to do it,but they won’t. has it bad in her hands as well but the pain comes and goes and says the pain never goes in her feet. Thanks for sharing your story and good luck with the future, Best Wishes and Take Care, Lee.

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