First MTP Joint Interposition Arthroplasty

What is first MTP joint interposition arthroplasty? 

A first metatarsophalangeal (MTP) joint interposition arthroplasty treats arthritis of the big toe. This procedure stops pain by
X-rays showing a normal first MTP joint (above) and arthritis in a first MTP joint (below).

  preventing the surfaces of the big joint of the big toe from rubbing together.

What are the goals of first MTP joint interposition arthroplasty?

The primary goal is to lessen pain.

What signs indicate surgery may be needed?

First MTP joint interposition arthroplasty is used to treat severe first MTP joint arthritis. The main symptoms are pain and loss of motion at the joint between the big toe and the foot. Your orthopedic foot and ankle specialist will examine you and take X-rays to determine the extent of your arthritis.

When should I avoid surgery?

Patients with infection or blood vessel disease should not be considered for the surgery. Young age and poor skin around the joint or large deformity are sometimes barriers to surgery. Diabetics should consult their doctor before this surgery.

General Details of the Procedure

An incision is made over the first MTP joint and carried down to the joint. The joint capsule is then opened up to expose the diseased joint. The joint surfaces along with a small amount of bone are removed from the arthritic joint. The space that is created is then filled with your own tissue and sewn into place. The joint capsule and skin are closed with stitches. 

Specific Technique

Deformity may be corrected during the surgery. There are alternatives that can be used instead of your own tissue. These include a tendon graft from another part of your body, a donor human tissue graft (allograft) or a graft from another source such as materials derived from animals (xenografts) or from artificial material (synthetics).Your orthopedic foot and ankle surgeon should discuss these alternatives.

What happens after surgery?

After the surgery, a soft dressing of gauze and tape is placed over the toe and foot. The joint should be immobilized followed
X-ray after first MTP joint interposition arthroplasty
by early motion to prevent stiffness. Physical therapy may be utilized to optimize motion and strength at the joint. Patients should keep their foot elevated as much as possible to reduce swelling. Stitches are generally removed at 10 to 15 days, depending on the condition of the skin.  Patients are then encouraged to wear a hard-soled shoe.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
One of the most frequent complications of first MTP joint interposition arthroplasty is failure to relieve pain or preserve motion. Another complication is rejection of the tissue placed in the gap. This may require further surgery.
Other complications can include pain at the base of the second toe, delayed wound healing, recurrent deformity, bony overgrowth, disintegration of bone around the graft, implant displacement, instability of the joint and injury to the nerves of the big toe. 

Frequently Asked Questions

Will I have to be off of my foot?
Rehabilitation protocols vary from surgeon to surgeon.  There may be a brief period of time where you should not weight bear but in general you will get back to limited walking within a few weeks after your surgery. 
When can I return to work?
It depends on the requirements of your occupation and your individual pain tolerance. When you can tolerate pain without pain medication and you are able to walk without assistive devices you can return to a sedentary occupation (desk work, etc.). For more physically strenuous occupations, the time until it is safe to return to work will be longer, perhaps as long as 12 weeks. You and your physician can decide when it is right for you to return to work. 
Can I play sports after first MTP joint interposition arthroplasty?
Strenuous physical activity can lead to early failure.  Light activity, such as walking and cycling, can be performed after the initial healing is complete.
Will first MTP joint interposition arthroplasty improve my range of motion?
It is unlikely that you will regain more motion than you had prior to surgery. 
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.