First MTP Joint Replacement

What is a first MTP joint replacement? 

A first metatarsophalangeal (MTP) joint replacement treats arthritis of the big toe. The joint is removed and replaced with

X-rays showing a normal first MTP joint (above) and arthritis in a first MTP joint (below).

 metal, plastic or a combination of both.

What are the goals of a first MTP joint replacement?

The primary goal is to lessen pain. Another goal of the surgery is to retain motion and improve the position of the big toe.

What signs indicate surgery may be needed?

First MTP joint replacement 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 surgeon will examine you and take X-rays to determine the extent of your arthritis.

When should I avoid surgery?

Patients with infection, blood vessel disease or allergies to the implant 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. Those who engage in excessive activity may overload the MTP joint and wear it out, which should be considered before surgery.

General Details of the Procedure

An incision is made over the first MTP joint and carried down to the joint. The joint surfaces along with a small amount of bone are removed from the arthritic joint. Bone spurs are removed. The canals of the bones are then opened and the implants are placed. The joint capsule and skin are closed with stitches. 

Specific Technique

Deformity should be corrected during the surgery, as the implant will fail if it is not addressed. There are many different types and brands of implants. The proper one will be determined by you and your orthopedic foot and ankle surgeon. 

What happens after surgery?

After surgery, a soft dressing of gauze and tape is placed over the toe and foot. The joint is initially immobilized but early motion is started to prevent stiffness. Physical therapy may be utilized to increase motion and strength at the first MTP joint. You should keep the foot elevated as much as possible to reduce swelling. Stitches are usually removed 10 to 15 days after surgery. You will then wear a hard-soled shoe.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection,

X-ray showing synovitis after first MTP joint replacement
 damage to nerves and blood vessels, and bleeding or blood clots.
With first MTP joint replacement, one of the most frequent complications is silicone synovitis, which can occur if a silicone implant is used. This is caused by small particles of silicone wearing off of the joint replacement implant. 
Another complication is failure of the implant and need for further surgery. Other complications include death of the bone due to interruption of the blood supply, infection, pain at the base of the second toe, and delayed wound healing. There can be recurrent deformity, bony overgrowth and disintegration of bone around the implant. Additionally implant displacement, instability of the joint, and injury to the nerves of the big toe can occur. 

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 put weight on the foot, 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 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 decide when it is right for you to return to work. 
Can I play sports after first MTP joint replacement?
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 replacement improve my range of motion?
It is difficult to predict how much motion a patient will regain.
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