The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint resection arthroplasty treats arthritis of the big toe.
This procedure stops pain by preventing the surfaces of the big joint of the big toe from rubbing together.
First MTP joint resection arthroplasty is used to treat severe first MTP joint arthritis. The main symptoms are pain and 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.
Patients with infection or blood vessel disease that would prevent healing should not consider this surgery. Young age, poor skin around the joint, or large deformities are sometimes barriers to surgery. Diabetics should consult their doctor before this surgery.
This is not the procedure of choice for most big toe arthritis cases as the procedure results in a toe that does not function well. However, it is useful for patients with lower physical demands.
Specific Technique
Your foot and ankle orthopaedic surgeon will make an incision over the first MTP joint and carry it down to the joint. The joint capsule is opened to expose the diseased joint. The joint surfaces along with a small amount of bone are removed from the arthritic joint. This creates a space for tissues to be placed around the area and sewn together to stabilize the space. Finally, the surgeon closes the joint capsule and skin with stitches. The space created may eventually fill with scar tissue.
After the surgery a gauze dressing and tape is placed over your toe and foot. The first MTP joint should be immobilized, followed by early motion to minimize stiffness. Physical therapy may be used to increase motion and strength. Patients
should keep their foot elevated as much as possible to reduce swelling. There may be a brief period of time where you should not put weight on your foot but in general you will get back to limited walking within a few weeks of your surgery. Stitches are removed 10-15 days after surgery, depending on the condition of the skin. Patient should then wear a hard-sole 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.
Patients may suffer from a "floppy" big toe that lacks power and function. This "floppiness" may bother patients during even minor activities such as dancing. Other complications include delayed wound healing, recurrent deformity, bony overgrowth, disintegration of bone, instability of the joint, injury to the nerves of the big toe, and increasing pain under the ball of the foot.
When can I return to work?
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.
Can I play sports after first MTP joint resection arthroplasty?
Moderate to strenuous physical activity traditionally has not been possible with this procedure. Light activity, such as walking and cycling can be performed after initial
healing.
Will first MTP joint resection arthroplasty improve my range of motion
You may not get more range of motion than you had prior to surgery.
Last reviewed by Jeff Feinblatt, MD, 2020
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