What is a First MTP Medial Capsulorrhaphy?

First MTP medial capsulorrhaphy is a procedure that tightens the soft tissue on the inner side of the big toe joint. This procedure is done along with other procedures to help correct a bunion deformity. It should not be performed alone due to the likelihood of the bunion returning. Bunions involve both an altered position of the bones of the foot as well as a stretching of the soft tissue around the joint, which allows the big toe to turn inward toward the second toe. Both of these should be addressed to allow long-term correction of a bunion.

The goal of tightening the soft tissue is to restore normal tension of the previously stretched out tissue, aiding in pain relief pain by straightening the big toe. Bunion procedures also may improve the cosmetic appearance of the foot but should not be done for this reason alone.

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 shoes. You should first try non-operative treatments, such as wider shoes or use of a donut pad or toe spacer. 

Surgery should not be performed for cosmetic reasons or if the bunions are painless. You also should avoid surgery if you have an active infection, poor blood flow, uncontrolled diabetes, or if you have not tried conservative treatment options. When in doubt, or if you have had failure of a previous bunion procedure, obtain a second opinion from a foot and ankle orthopaedic surgeon.


As with all bunion procedures, the soft tissue procedure is performed as an outpatient, meaning the patient can go home the same day as surgery. The big toe is realigned, and the tissue is tightened to hold it in a straight position. The prominent bone at the inside of the big toe knuckle is shaved off to decrease the prominence as well as aid in healing of the soft tissue. A separate cut and shift of the bone is performed to help maintain the correction. 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 (bursa) between the skin and bone is removed. The bony 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.


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 10-12 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 to aid in balance. It’s also important to keep your surgical dressings dry. Restricting activities will help to reduce complications as well as pain and swelling. Your doctor may ask you to do range-of-motion exercises to maintain flexibility and avoid stiffness and may order physical therapy depending on your recovery. 

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.

Risks and Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

The soft tissue procedure is a relatively safe surgery with few complications. However, even when bunion surgery is performed correctly, the bunion can return, or the toe can go the opposite direction. The toe is commonly stiff after a bunion procedure and does take time to improve. The chances of recurrence can be reduced by following instructions and wearing shoes with lots of room for your toes.


Are there any metal devices or implants put in my foot?
The soft tissue procedure often can 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. The other bunion procedure (bone cut and shift) is typically fixed in some way with a wire, pin, screw or plate and screws.

How long will I have to be off of my foot?
This will depend on the other procedures performed to correct your bunion. In some cases, after a few days your orthopaedic surgeon may allow you to walk on your heel only in a fracture shoe or boot. In other cases, you will need to be off the foot until bone healing has occurred. 


Original article by Ashish Shah, MD
Last reviewed by Jeffrey Feinblatt, MD, 2018

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