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 allow the big toe to shift 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. 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. It may also be needed if you have other painful problems in the foot related to the bunion, such as a painful hammertoe. 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 surgery, 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
Your foot and ankle orthopaedic surgeon makes a cut on the inside of the big toe joint. They will remove the inflamed fluid sac (bursa) between the skin and bone, and shave the bony prominence at the big toe joint to remove the painful bump. A bony correction procedure 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. Your 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 your foot or only put weight on your heel for a period of time determined by your surgeon. Stitches usually are removed after 2 weeks.
Most bunion surgery needs some type of bunion splint or tape and a surgical shoe for about 6-12 weeks, depending on the surgery you had and your surgeon's preferences. 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 to help you walk. It's also important to keep your surgical dressings dry. Restricting activities will help to reduce pain and swelling, and will help your incisions heal better. Keeping activity to a minimum will also help prevent complications. 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.
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 this does take time to improve. It may be a year before your foot feels "normal" again. The chances of recurrence can be reduced by following instructions and wearing shoes with lots of room for your toes.
The soft tissue procedure often can be accomplished with stitches alone. However, some foot and ankle orthopaedic surgeons will use a small anchor to hold the tightened capsule to the bone. This anchor will remain in your foot. The other parts of the bunion correction (bone cut and shift) are typically fixed in some way with hardware such as a wire, pin, screw, or plate and screws.
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 start weightbearing as tolerated or 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, typically 6 weeks.
Original article by Ashish Shah, MD
Contributors/Reviewers: Jeffrey Feinblatt, MD; Elizabeth Cody, MD
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