Big Toe Joint Fusion

Pros and Cons of Big Toe Joint Fusion

Pros and Cons of Big Toe Joint Fusion: This is the most predictable procedure available to the foot and ankle surgery. This is reliable and essential ensures you will only need one surgery if your life if all goes well. The down side is that it is very permanent and you will no longer have motion in the joint.


Pros and Cons of Big Toe Joint Fusion:

The big toe joint fusion is recognized as being the  “most permanent and satisfactory correction of hallux valgus(bunion)”. Numerous studies over the years have indicated that this is the most predictable and effective surgery for any type of bit toe joint deformity or arthritis.


Pros and Cons of Big Toe Joint Fusion
Pros and Cons of Big Toe Joint Fusion


Pros of Big Toe Joint Fusion:

  • Better long term results and happiness.
  • More stable.
  • Better pushoff strength.
  • It will not shorten over time like a arthroplasty might(more chronic arthritis will develop).
  • Long term durability.
How big can a bunion get
How big can a bunion get? This particular bunion is 38 degrees, but some can get even bigger. Some can be close to 90 degrees.
Huge bunion deformity left vs. right foot
The left foot is a fairly normal bunion angle, the right side is a very large bunion developing with early arthritis in the joint.

Cons of Big Toe Joint Fusion:

  • Longer recovery time.
  • No joint motion means less shoe options.
  • Shorter bone may mean less contact to the floor(more pressure on the 2nd metatarsophalangeal joint).
  • No going back unless you get more surgery.


1st MTPJ fusion before and after.
1st MTPJ fusion before and after. This type of surgery definitely takes a little bit longer to heal.


Frequently asked questions:

Primarily used for Hallux Abducto Valgus and Hallux Limitus:

  • The big toe fusion is called a McKeever bunionectomy. It is primarily used for both severe hallux abducto valgus deformities(bunions) and stiff big toe joints due to osteoarthritis termed hallux limitus and hallux rigidus.
1st metatarsal phalangeal joint fusion
1st metatarsal phalangeal joint fusion. The left side is the before and the right side is the after.




Secondarily used for Repair of Failed Surgeries

  • The big toe fusion is secondarily used to repair severe/recurrent hallux abducto valgus, failed implant joint arthroplasty (remodelling), hallux varus, primary first MPJ osteoarthritis, post traumatic arthritis, inflammatory and septic arthritis and various other neuromuscular conditions.



2 screw MTPJ fusion
2 screw MTPJ fusion was how the big toe was previously fused. A plate can be a little more expensive but the big toe joint certainly holds together much better.


1st MTPJ fusion locking plate
1st MTPJ fusion locking plate sits right against the bone. The plate is usually very thin and presses right against the bone. Plates have gotten very thin and strong over the years. With titanium the odds of an allergy are almost unheard of.


People are Usually Very Happy with the Operation

  • An appropriately fused big toe joint has shown to have the greatest long term patient happiness from a recurrence standpoint, a pain standpoint and a functionality standpoint.It seems that the only problem is the psychology behind telling a patient that their joint will be fused and they expect that it is much worse than it really is.
Arthritic bunion deformity
Arthritic bunion deformity with a dislocation is visualized here. This usually can not be fixed with a “lesser” bunion procedure, a fusion would be more indicated if there is arthritis.

Should I Remodel the Joint or Fuse the Big Toe?

  • The big toe joint fusion has the benefit of locking the toe in proper position as well as removing pain in the joint. The big toe joint arthroplasty (remodelling) procedure is beneficial in the case where the position is not a big problem such as in a straight joint with a mild amount of joint damage; the arthroplasty is also beneficial because it allows for more types of shoes to be worn. The benefits of the big toe joint fusion (arthrodesis) is that you will have a greater degree of pushoff strength in the joint and essentially guaranteed prevention of future pain and improper positioning if all goes well with the surgery. The arthroplasty has a quicker healing time but weaker pushoff strength (less of a problem if the patient is already apropulsive).
  • Pros: More stable, Better pushoff strength, Better long term results and happiness, will not shorten over time like a arthroplasty might(more chronic arthritis will develop).
  • Cons: Longer recovery time, No joint motion means less shoe options, shorter bone may mean less contact to the floor(more pressure on the 2nd metatarsophalangeal joint).
Hallux rigidus that may require a first MTPJ fusion.
Hallux rigidus that may require a first MTPJ fusion, the fusion rates in this case are very close to 95-98% in recent large level studies, they are much higher than they have been in the past.

Who should Avoid Big Toe Fusion

  • People who need to kneel and bend should choose remodeling over fusion. Bowlers and carpet layers need to bend their big toe joint every day, people like this should avoid it.
  • People who cannot tolerate being immobilized in a boot for any extended period of time(cast or CAM Walker).
  • Anyone who plans to wear heels larger than 1″ tall. This will basically cause you to develop hallux rigidus as the big to will press against the floor in its fused position, causing a callus to form on the inside of the big toe.
Big Toe Fusion Operation:
  • A detailed guide on the principles of the surgery and how it is performed by the podiatrist.


Big Toe Fusion Recovery Time :
  • A rough estimate on how long it will take for your joint to fuse and what you can do to speed that up.


Big Toe Fusion Complications:

-Nonunion and mal-position are the two major complications.

-Nonunion- this can be prevented by proper fenestration and ensuring that the patient does not have any systemic problems such as smoking or diabetes. If this does occur the painful non-union will need to be excised and then filled in with a bone graft.



Bone Spur on Top of the Foot Surgery Recovery Time Protocol:

This guide will detail the length of specific step by step bone spur surgery recovery time.


Day 1: Top of the Foot Spur Removal Surgery Day:

  • The actually surgery takes well under an hour, and your foot is usually numbed up for the rest of the day.
  • Some people don’t need much if any pain medication outside of anti-inflammatories. If you do have pain to this site, then it is normal to have a prescription for a narcotic pain medication for the days immediately after the surgery.
  • After surgery you will wake up with a dressing on your foot. Keep this dressing in place and your pain will be well under control with medication.
  • No implants or bone healing is necessary, except for the healing of bone pain.
  • You can wear a boot over your dressing almost immediately.
  • Most physically able people do not need crutches or a walker unless they have other health issues.
  • Usually there are about 2 sutures in the foot.
Heel spur surgery icing and dressing
This is what your dressing will look like immediately after surgery. The best thing to do is to elevate it , keep it protected and get some rest!



Day 7:  Top of the Foot Bone Spur Removal Surgery Postoperative Visit #1:

  • Within about a week, we have the first postoperative visit.
  • You will have an X-ray at this visit and we will make sure there is no irritation or damage to your dressing.
  • With this dressing change some antibiotic ointment is applied, we make sure you are not having any problems at this time.
  • Sutures are not removed yet at this visit.
The incision site will stay covered with the stitches in place following the surgery.

Week 2-3: Top of the Foot Bone Spur Removal Surgery Postoperative Visit #2:

  • This can fluctuate depending your overall health needs, physical fitness and life needs.
  • If you are able to rest more, weight less and are really healthy, sutures can usually come out at 2 weeks. Some patients need to walk and be more active, if this is the case you will likely need sutures longer and have a larger dressing.
  • If you swell more and are more tender, they can stay in a little bit longer.
  • If you are a smoker or have decreased healing ability, we may need to keep your sutures in place longer.
  • At this point your incision site should be healed.
  • At this point you will wear a band-aid for 2 weeks and walk in a good supportive running shoe.


Week 5: Postoperative Visit #3:

  • This is what the incision site will look like after the sutures are removed at 2-3 weeks or so.
  • If everything looks good, you no longer need to wear a band-aid.
  • At this point you will still be sore but can transition back into


2 Months: Postoperative Visit #4:

  • At this point you continue wearing a good supportive orthotic and good shoe.
  • If everything is feeling well you should be close to healed.
  • Keep in mind that you will continue improving for about 6 months total. But at this point you should be feeling better than you did prior to when you have a heel spur.
  • Congratulations you



Treatment algorithm for bunion surgery:
  • Find out if a different procedure is best for you.
  • A metatarsal joint fusion may not always be worth it.
  • Many times other procedures are just as effective and the healing time can be much quicker.


Resources for Big Toe Joint Fusion:

Big Toe Joint Fusion.