The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint replacement treats arthritis of the big toe. The bone on either side of the joint is partially removed and replaced with metal, plastic, or a combination of both. First MTP joint replacement can lessen pain and retain motion. Your foot and ankle orthopaedic surgeon is especially suited to discuss the details of this procedure as orthopaedic surgeons pioneered joint replacement and continue to be on the forefront of research and development in this area.
First MTP joint replacement is used to treat severe first MTP joint arthritis. The main symptoms are pain, especially at the top of the joint, as well as loss of motion at the joint between the big toe and the foot. Your foot and ankle orthopaedic surgeon will examine you and take X-rays to determine the extent of your arthritis and advise you on your treatment options.
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 deformities are sometimes barriers to surgery. Diabetics should consult
their doctor before this surgery. Activity levels should also be considered before surgery as those who engage in excessive activity may overload the MTP joint and wear it out, causing it to fail early.
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 and any bone spurs are removed. The foot and ankle orthopaedic surgeon makes a small channel in the bone to place the implant. The joint capsule and skin are closed with stitches.
Any deformity should be corrected during the surgery, as the implant will fail if it is not well-aligned. There are many different types and brands of implants. The best one will be determined by you and your foot and ankle orthopaedic surgeon.
After surgery, a gauze dressing and a wrap such as elastic wrap is placed over the toe and foot. The joint is initially immobilized but early motion is started to prevent stiffness. 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 surgery. Physical therapy may be used to increase motion and strength. You should keep the foot elevated as much as possible to reduce swelling. Stitches usually
are removed 10-15 days after surgery. You will then wear a hard-soled shoe.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Specific complications for joint replacement include failure of the implant and need for further surgery. These can be associated with death of the bone due to interruption of the blood supply, transfer pain to the second toe, recurrent deformity, bony overgrowth, disintegration of bone around the implant, implant displacement, instability of the joint, and injury to the nerves of the big toe. Joint replacement failure can make subsequent fusion or additional joint replacement difficult.
Silicone joint replacements were widely used years ago but much less so now, because it frequently is associated with silicone synovitis. Small particles of the silicone implant wear off, creating inflammation of the joint that causes bone
resorption (bone loss) and makes the implant fail and more difficult to reconstruct.
It depends on the physical requirements of your work and your individual pain tolerance. When you can tolerate pain without pain medication and you can walk without assistive devices you can return to a sedentary occupation (desk work, etc.). For more physically strenuous occupations, it could take as much as 12 weeks to safely return to work. You and your foot and ankle orthopaedic surgeon can decide when it is right for you to return to work.
Strenuous physical activity such as running, jumping, and rock climbing is thought to lead to early failure of the procedure. Light activity, such as walking and cycling, can be performed after the initial healing without significant risk of early failure. Again, this is a matter to be discussed with your foot and ankle orthopaedic surgeon.
Ideally but not necessarily. It is difficult to predict how much motion a patient will regain after complete healing.
Original article by David Macias, MD
Contributors/Reviewers: F. Ray Nickel, MD; Jeff Feinblatt, MD
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