First MTP Medial Capsulorrhaphy

​What is first MTP medial capsulorrhaphy?

First metatarsophalangeal medial capsulorrhaphy (MTPMC) is a procedure to tighten the soft tissue envelope that surrounds the big toe joint. This procedure is done to help correct a bunion deformity. Bunions can cause the soft tissue around the joint to stretch out over time, which allows the big toe to turn inward toward the second toe.

What are the goals of first MTP medial capsulorrhaphy?

The goal of MTPMC is to relieve pain by straightening the big toe. The procedure is often performed along with other bunion-correcting procedures. MTPMC may also improve the cosmetic appearance of the foot by straightening the big toe but should

A view of the soft tissue envelope around the big toe joint before it is opened during surgery.
not be done for this reason alone.

What signs indicate surgery may be needed?

The main reason people should have surgery is to relieve pain. Bunion surgery may be needed if your big toe has a painful bump or you have skin irritation on the bump due to rubbing from shoewear. You may have already tried non-operative treatments, such as splints and wider shoes, with no pain relief.

When should I avoid surgery?

Surgery should not be performed for cosmetic reasons or if the bunions are painless. You should also avoid surgery if you have active infection, poor blood flow and uncontrolled diabetes or if you have not tried enough conservative treatment options. If you have a severe deformity or extensive arthritis in the affected joint, a medial capsulorrhaphy alone may not be the correct procedure for you.

General Details of Procedure

MTPMC is performed as an outpatient procedure, meaning patients generally go home a few hours after surgery. The big toe is realigned and the tissue is tightened to hold it in a straight position. Most of the time, the prominent bone at the big toe knuckle is shaved off. Removing the bony prominence and straightening the toe generally relieves the pain associated with the bunion and gives the foot a more normal appearance. This often allows a shoe to fit more comfortably.

Specific Techniques

A cut is made on the inside of the big toe joint. The inflamed fluid sac between the skin and bone is removed. The bony

​​Stitches close and tighten the soft tissue envelope after big toe surgery.

prominence at the big toe joint is shaved to remove the painful bump. If any other bony correction is needed, this is done at the same time. If the joint lining that covers the big toe joint has stretched out over time, this will be tightened. The orthopaedic foot and ankle surgeon does this by cutting out a section of loose tissue and stitching it back together in a tighter position.

What happens after the surgery?

A dressing will be applied by your orthopaedic surgeon in the surgery room, and you will be given a surgical shoe or boot. You must avoid putting weight on the foot or only put weight on the heel for a period of time determined by your surgeon. Stitches usually are removed after two weeks.
Most bunion surgery needs some type of bunion splint or tape and a surgical shoe for about 10 to 12 weeks. You will be asked to elevate your foot at about the chest level for the first few weeks after surgery. You may need to use crutches or a walker in the first few days after this surgery. Restricted activities will help to reduce complications as well as pain and swelling. Your doctor may ask you to do range-of-motion exercises (bending the knee, hip or ankle) to maintain flexibility and to avoid stiffness. It’s also important to keep your surgical dressings dry.
Your orthopaedic surgeon may determine you should have physical therapy. Also note that swelling and trouble fitting into a regular shoe are very common after foot surgery and may be a challenge for three to six months depending on the complexity of the surgery. Compression stockings and physical therapy can be helpful in reducing swelling.

Potential Complications

There are complications that relate to surgery in general. These include risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
First MTPMC is a relatively safe surgery with few complications. However, even when bunion surgery is performed correctly, sometimes the bunion can return. The chances of recurrence can be reduced by following instructions and wearing shoes with lots of room for your toes.

Frequently Asked Questions

Are there any metal devices or implants put in my foot?
The goal of first MTPMC is to remove the painful bump and straighten the big toe by tightening the soft tissue envelope of the joint. This can often be accomplished with stitches alone. However, some orthopaedic surgeons will use a small anchor to hold the tightened capsule to the bone. This anchor will remain in your foot.
How long will I have to be off of my foot?
For a brief period of time after surgery, you should not put weight on the foot. In some cases, your surgeon may allow you to walk on your heel only.
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.