Understanding First MTPJ Fusion
What Is First MTPJ Fusion and When Is It Needed? Relief for Hallux Rigidus & Big Toe Arthritis
First MTPJ fusion is a surgical procedure used to treat severe arthritis or joint damage in the big toe, often caused by hallux rigidus. This operation fuses the first metatarsophalangeal joint (MTPJ), reducing pain and improving stability. If conservative treatments have failed, this option may provide lasting relief. At Balance Foot & Ankle in Michigan, Dr. Tom Biernacki and his team specialize in delivering personalized care before, during, and after your surgery.
First MTPJ Fusion: A Closer Look at Procedure, Recovery, and Benefits
First MTPJ fusion works by eliminating movement in the arthritic or damaged big toe joint, effectively reducing pain and restoring foot function. The procedure involves aligning the bones in the joint and fusing them with plates or screws. Recovery may take 6–8 weeks, with a gradual return to walking and daily activities. With a high success rate, first MTPJ fusion can be life-changing for individuals suffering from chronic big toe pain and mobility issues. Dr. Tom Biernacki offers expert care and thorough guidance through each stage of the process, helping patients return to a pain-free lifestyle.
1st MTPJ Fusion Surgery Recovery Time Causes, Symptoms & Best Treatment!
1st MTPJ fusion surgery recovery time can vary, but you may even be walking the same day! Incision site healing can be 2-3 weeks, pain for 6-8wks!
Big Toe Joint, Hammer Toe & Bunionette Problems:
Ready to Walk Pain-Free Again?
Don’t let big toe pain hold you back. Schedule a consultation with Dr. Tom Biernacki at Balance Foot & Ankle in Howell or Bloomfield, Michigan. Whether you’re considering first MTPJ fusion or exploring other options, we’re here to help you find the most effective and affordable path forward.
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Top 10 Facts About First MTPJ Fusion Surgery
Relieve Chronic Big Toe Pain with This Proven Procedure
If you’re suffering from constant big toe joint pain and stiffness, First MTPJ Fusion may be the long-term solution you’ve been searching for. This highly effective procedure is designed to relieve pain caused by severe arthritis or joint deterioration in the big toe, also known as hallux rigidus. Here are the top 10 facts you need to know about First MTPJ Fusion surgery and how it could improve your quality of life:
1. What is First MTPJ Fusion?
First MTPJ Fusion stands for “First Metatarsophalangeal Joint Fusion.” It’s a surgical procedure that fuses the joint at the base of the big toe, effectively eliminating painful motion and providing a stable, pain-free toe.
2. It’s the Gold Standard for Hallux Rigidus
This procedure is considered the most reliable and effective treatment for advanced hallux rigidus, a condition marked by stiffness, swelling, and pain in the big toe joint.
3. Ideal for Chronic Pain That Doesn’t Respond to Conservative Care
When physical therapy, shoe inserts, and medications no longer work, First MTPJ Fusion is often the next best step. It offers long-term relief for patients who’ve exhausted non-surgical treatments.
4. High Success Rate
This surgery boasts an impressive success rate of over 90%, with most patients experiencing significant pain relief and improved mobility.
5. It Involves Bone Fusion
During the procedure, the surgeon removes damaged cartilage and aligns the joint surfaces. These are then fused using plates and screws to prevent further motion that causes pain.
6. Recovery Can Take 6 to 8 Weeks
You’ll need to stay off your foot for a few weeks and wear a surgical boot. With proper care, most patients return to walking comfortably within two months.
7. The Toe Won’t Bend, But It Won’t Hurt
While the fused joint won’t move like before, patients are typically able to walk, hike, and even run without discomfort.
8. Custom Footwear Helps Post-Surgery
Special shoes or orthotics may be recommended after surgery to support foot function and accommodate your fused joint.
9. Performed by Specialists Like Dr. Tom Biernacki
At Balance Foot & Ankle in Michigan, First MTPJ Fusion surgery is expertly performed by Dr. Tom Biernacki, who has helped thousands of patients recover from chronic toe joint pain.
10. It’s a Long-Term Solution
Most patients experience permanent relief after this procedure, making it a dependable fix for debilitating big toe arthritis.

Considering First MTPJ Fusion?
Get expert care from Dr. Tom Biernacki at Balance Foot & Ankle in Howell and Bloomfield, Michigan. With over hundreds of patients helped, our team focuses on what works—safe, effective, and affordable treatment.
Let me know if you’d like this in a downloadable format or adapted for a blog or print infographic.
Big Toe Joint Arthritis & Hallux Rigidus Picture Gallery:
Look:
- Do you have a stiff big toe? This might mean that there is arthritis developing within your big toe joint.
- If you have a slight decrease in motion, this is called hallux limitus.
- If the big toe joint does not bend at all, this is called hallux rigidus.
- This does mean that there is destruction of your cartilage within the joint.
- As the joint keeps getting more and more damaged, it starts to develop a very large spur on the big toe joint.
- It is possible to also have a bunion in the big toe joint arthritis.
- It is possible to have sesamoiditis and big toe joint arthritis.
- It is possible to have a turf toe and big toe joint arthritis, although little bit less likely.
So, click on the gallery to see a description & full size photos!
First MTPJ Fusion Surgery Recovery Time Overview:
- 1st MTPJ fusion surgery recovery time can vary, but you may even be walking the same day!
- Incision site healing can be 2-3 weeks, pain for 6-8wks!We believe in performing a robust fixation where you only need the surgery performed once.
- This allows for early weight bearing time and high levels of fusion.
First MTPJ Fusion Surgery Details:
The entire surgery is performed in about two hours and you may go home on the same day. This is performed on an outpatient basis.

Is This Surgery Covered by Insurance?
In most cases this is done for severe pain and is not considered a cosmetic or “elective” procedure. It is generally essential.

First MTPJ Fusion Technique:
- An incision is made on top of the big toe.
- Remaining cartilage is cleared away to allow the two bones to heal together.
- Your podiatric surgeon may use a combination of tools to shape each bone for a perfect fit.
- Once prepared, the two bones are positioned and a metal plate is placed to hold both bones together.
- Two screws can be placed across the joint without using a plate.
- After the hardware is placed, the incision is closed with sutures and the foot is placed in a dressing or splint.F

First MTPJ Fusion Surgery Recovery Time:
- You will likely be examined at 1 week, two weeks, and sutures removed at three weeks.
- We will then see you at 2 months and 3 months following the surgery.
- X-rays may be taken at each visit to evaluate the bone healing and the position of the big toe.
- Weight bearing status generally begin in an immbolizing boot within a few days of surgery.
- After a first MTP fusion, you should not wear shoes that put extra stress on the joint for atleast 2-3 weeks.
1st MTPJ Fusion Surgery Complications That Can Lengthen Healing Time:
- Common complications specific to MTP fusion include poor or delayed bone healing, infection, and stiffness in neighboring joints.
- The metal plate used during surgery can sometimes cause irritation. In this case it can be removed after the bone has healed.
- Finally, scarring within the joint can limit neighboring tendons.
- 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.

If I Have a 1st MTPJ Fusion, Eill I Still Be Able To Run?
- The only reason you would have this procedure performed is if you were have pain or a problem already, the expected resulted is better function than when you can in for surgery.
- Most people with a first MTP fusion do not have a limp after it has fully healed.
MTPJ Fusion Surgeons:
- Generally this is a procedure performed by podiatrists and orthopedic foot and ankle surgeons.
MTPJ Fusion links:
MTPJ Fusion Surgery Locations:
- We are able to accommodate you for a quick turnaround time and result at one of our many Michigan locations.
- Come see use and realize how quickly you can expect 1st MTPJ fusion surgery recovery time to take.
Big Toe Joint Home Treatment Infographic

Big Toe Joint Injury or Surgery Treatment:
- If you think you might have a severe turf toe, a severe tear or sprain, a broken big toe joint or broken big toe, or you have just had surgery: this guide may be able to help you!
- Just make sure to check with your podiatrist because a severe injury will require imaging, biomechanical evaluation, and a good discussion to prevent anything from going more wrong.
- For surgery, purposes make sure to discuss with your podiatrist To see what is recommended, as every surgery is unique, and there are pros and cons to all treatment methods.
Big Toe Joint Fracture, Sprain, or Surgery Products:
- If you have a traumatic injury such as a broken bone or ligament tear, these products may be able to help you.
- The best way to do this is, of course, to see your podiatrist and get evaluated with an x-ray, ultrasound, and potentially even an MRI or CT scan.
- If you cannot do so, it may benefit you to be in a cast, fractured boot, or even keep the weight off of it with a rolling knee scooter or other protective devices.
- We as podiatrists frequently take patients off work for a very long period of time when they suffer a traumatic injury. Unfortunately, there is no other way around us in labor jobs.
- If you have a sit-down job, there are ways to get people back to work quicker, but this can be impossible otherwise.
- Just remember these injuries can take a very long time, specifically 2 to 3 months or more, to come back from if you’re going to be on your feet all day. There is a long recovery time and healing time in most cases.
Big Toe Joint Injury & Surgery Immobilization:
- There are pros and cons to using a boot to treat your big toe joint injury. If you are immobilized too long, the cons are that you will gradually become stiff and overworked to your other leg.
- The Pros are that your injured heel will hopefully have a chance to heal gradually!
- Our favorite fracture boots and their supplies:








Big Toe Arthritis and Hallux Rigidus:
- One of the best treatment options for a stiff big toe is a stiff orthotic.
- The big toe can become arthritic, and what causes the pain is the bone grinding on a joint that cannot move.
- Getting a rigid carbon insole can make a huge difference in preventing the bend of the big toe joint.
- Out of the big toe joint products in the next table, the carbon insole is worth looking at for relieving the big toe joint bed.
- A good over-the-counter orthotic can provide a similar result, and we would otherwise prefer those.








Offloading and Scooter Treatment:
- If you cannot use your foot, it needs to be immobilized: we have found success with offloading the scooters in these products.
- Crutches can be difficult long term, whereas scooters can really help you get around and to work if you have a sit-down job in this been okay-ed with your podiatrist.
- These are our favorite knee scooters and walking devices:








Best Big Toe Joint Products:
- There are usually two phases to treating big toe joint pain
- The two phases of treatment include controlling the acute inflammation with protection and correcting the biomechanics, which led to the problem in the first place.
- If the tendons, joints, and ligaments are inflamed, they are almost frozen in place and cannot function properly.
- Inflammation can mean damage as well, in this most likely needs to be protected as the big toe joint heavily relies upon the weight-bearing joint. So consider discussing with your podiatrist the need for and offloading surgical shoes or boots.
- Once the inflammation is decreased, we need to correct the biomechanical causes to ensure that they can never become overworked and inflamed again!
- The key with an injury or surgery is to keep it protected initially, and when the bone and tendon heels, to get moving before stiffness can set in.
Best Bunion Specific Products:
- There are no perfect bunion treatment products.
- Most people end up disappointed after spending a lot of money on bunion pads, bunion gel pads, expensive bunion correctors, and bunion splints!
- The truth is a bunion is a biomechanical injury. The foot is flattening out, and the ankle is flattening out, causing the pain.
- Having a gel pad on the big toe has very little chance of fixing the deformity, although it can stop the rubbing and relieve a lot of the pain.
- This is why people sometimes wear splints and correctors. It holds the toe straighter so that the tissue and were’s and have left pain.












Big Toe Joint Inflammation Control:
Massage & Ice Products:
- Ice is an excellent option that can be safe for almost everyone.
- There is some debate about whether icing is worth doing, but this can help limit the need for medications and keep your options open for chronic pain.
- This works great for your arch, less for the ball of the foot.
- The more muscle and ligament tissue there is, the better ice will work there.






Menthol Based Gels:
- Biofreeze is one of our favorites.
- This can work well as a cream or gel option for your big toe joint pain.
- These gels have been studied to work 2x as long as ice.
- This works great for the ball of the foot.
- This can be very effective for the bottom of the heel and Achilles tendon sore regions.








Massage Sticks:
- These can work great for loosening your muscles.
- This is not to be used directly onto your foot but to help take pressure off the foot’s front.
- This allows less tightness and pressure on the ball of your foot.
- This is very effective for the arch, the gastrocnemius, calf muscle, and the hamstring and thigh muscles.
- This also works very well for the gluteus muscles if you are having butt cheek or hip pain.






Remove the Big Toe Joint Pressure:
- The key is to prevent future pain and to keep pressure off of the big toe joint.
- This means keeping you active while keeping stress off of your big toe joint. This will prevent future bunions, sesamoiditis, turf toe, and even big toe joint arthritis!
- If you can get rid of the pain and swelling, this will let you start walking normally.
- If you can walk normally, the vast majority of your pain should gradually start to go away.
- The best way to ensure that your big toe joint, hammertoes, and foot and ankle ligaments are not overworked is to support them.
- The best way to support them is to use great orthotics and great shoes.
- Some people may also need to rely on supportive ankle braces and other supportive modalities.
Best Big Toe Joint & Flat Foot Shoes:
- Getting a great supportive pair of shoes will make sure that there is no further pressure onto the ball of your foot and the big toe joint region.
- This is especially important if you have plantar fasciitis, heel spur pain, or Achilles tendonitis.
- Consider shoes combined with a good supportive orthotic for the best pain relief!
- We have found shoes and orthotics to be one of the most effective ways to reduce bunion and hammertoe pain.
- The following link will show you what our favorites are.
Best Big Toe Joint & Flat Foot Orthotics:
- These are our recommended orthotics for offloading the big toe joint.
- Custom orthotics can work very well, but they should not be the first line of treatment. Custom orthotics can cost a lot of money, over the counter orthotics can be a great introduction to foot control and prevent pronation.
- There are different types of orthotics for different types of shoes.
- Women’s shoes usually need a less bulky orthotic but allow for less correction of your big toe joint and ball of the foot pain.
- A full-length orthotic requires a running shoe, boot, or comfortable walking/dress shoe.
- We recommend doing everything you can to get a good supportive shoe that can fit a full-length orthotic. This will get you the best results for your bunion, hammertoes, and bunionette.
- This is the best way to maximize your orthotics for great results.
Click this link for the best podiatrist recommended orthotics!
Best Full-Length Orthotics:
- These will only work in wider shoes or a good supportive running shoe.
- This will not work in sandals, flats, or most women’s dress shoes.








Best Dress Shoe Orthotics:
- These are a great choice for dress orthotics.






Best 3/4 Length Orthotics:
- These are great options for women’s dress shoes and thinner shoes.
- These are not the most supportive pair of orthotics.


Get A Great Dynamic Stretch:
- The goal of getting a great stretch is to improve your ankle flexibility and prevent ball of the foot pain and big toe joint pressure.
- It is possible to stretch on your own, but these products can also really help!
- This will take pressure off of the ball of your foot.
- We personally prefer this method of stretching.








Get A Great Static Stretch:
- These devices are great for stretching while you are resting.
- This will also help take pressure off of the ball of your foot.
- This works great for plantar fasciitis but can also make your ankle more flexible in removing pressure from the ball of your foot!
- It can be used while watching TV or at night time.






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Big Toe Joint, Hammer Toe & Bunionette Problems:
First MTPJ Fusion Surgery: Your Top 10 Questions Answered
It’s a surgical procedure that fuses the first metatarsophalangeal joint in the big toe to reduce pain and improve function.
Patients with severe arthritis, hallux rigidus, or failed previous treatments may benefit from this procedure.
The damaged joint surfaces are removed, and the bones are aligned and fused using metal hardware for stability.
Most patients recover in 6–8 weeks, with full return to activities taking 3–6 m
Yes, though the big toe will no longer bend, most people walk without pain after healing.
Yes, options include cheilectomy, joint replacement, or orthotics for earlier stages of arthritis.
Risks include infection, nonunion, nerve damage, or stiffness, though complications are rare with expert care.
Pain is managed with medication and most patients report significant relief after healing.
It’s rare, but nonunion or hardware issues can occur, especially without proper post-op care.
Dr. Tom Biernacki at Balance Foot & Ankle offers expert first MTPJ fusion in Howell and Bloomfield, Michigan.