First Metatarsophalangeal Joint Arthrodesis

Hallux rigidus is a form of arthritis that affects the joint at the base of the big toe. As the condition progresses, the smooth cartilage that normally allows the joint to move wears down. This leads to bone-on-bone contact and the formation of extra bone around the joint, which further limits upward toe movement and creates pain on the top of the joint, especially when walking or pushing off the ground, interfering with daily activities. In advanced cases, surgical fusion of the joint may be recommended.¹

First metatarsophalangeal (MTP) joint arthrodesis is considered by many to be the most reliable surgical option for advanced hallux rigidus.^1,2 It is a surgical procedure in which the two joints at the base of the big toe are permanently fused so that the joint no longer moves. The goal of the surgery is to relieve pain caused by severe arthritis.

During the procedure, the damaged joint surfaces are removed, and the toe is positioned in a functional and comfortable alignment for walking. The bones are then held together using metal screws and/or a small plate while they heal into a single solid bone. Although the big toe will no longer bend at this joint, fusion reliably relieves pain and allows patients to walk and wear shoes more comfortably.¹‍

First MTP arthrodesis is considered by many to be a reliable and durable procedure, but as with any surgery, complications can occur. The most common ones consist of:
‍
● Nonunion (5-9%): failure of the bones to fuse completely
● Malunion (≈ 6%): bones heal in a suboptimal position, sometimes leading to altered toe alignment
● Hardware removal (≈ 8.5%): persistent discomfort or pain related to screws or plates needing removal
● Interphalangeal joint disorder (≈ 8%): pain or deformity in adjacent toes (metatarsalgia, claw toe) due to altered foot mechanics ^3-5
‍
As for other surgeries, general risks related to surgery and anesthesia may include infection (<3%)⁶, bleeding, blood clots, allergic reactions, cardiopulmonary complications, and wound-healing issues. Any other general surgical and anesthesia-related risks will be discussed with you prior to surgery if applicable.

Before the surgery, your surgeon will examine your foot and obtain X-rays to assess joint damage and alignment. The procedure is usually performed under regional anesthesia (such as a nerve block) with potential sedation, or, alternatively, under general anesthesia.⁷

After surgery, your foot will be protected in a postoperative shoe or boot. Pain is typically managed using a multimodal approach, which may include acetaminophen and anti-inflammatory medications.

Most patients go home the same day or shortly after first metatarsophalangeal joint arthrodesis. Patients typically begin walking in a protective fracture boot within the first week; weight-bearing is allowed while wearing the boot to protect the fused joint as the bones heal.⁸

Swelling and discomfort gradually improve during the first several weeks, and follow-up visits with X-rays are used to confirm proper healing and alignment. Patients usually transition from the boot to a regular athletic shoe by about 6-7 weeks, and unrestricted activities are usually resumed by about 3-4 months, with most patients walking without pain and at a normal pace.⁸

Your surgeon will provide guidance on any activities to avoid and when it is safe for you to resume regular activities, and your follow-up appointments will ensure your recovery is on the right track.

Koutsouradis P, Savvidou OD, Stamatis ED. Arthrodesis of the first metatarsophalangeal joint: The "when and how". World J Orthop. 2021;12(7):485-494. Published 2021 Jul 18. doi:10.5312/wjo.v12.i7.485
‍
Budde K, Claassen L, Plaass C, Stukenborg-Colsman C, Daniilidis K, Yao D. Synthetic cartilage implant vs. first metatarsophalangeal arthrodesis for the treatment of hallux rigidus. Arch Orthop Trauma Surg. 2024;144(9):4343-4354. doi:10.1007/s00402-024-05534-9
‍
Izzo A, D'Agostino M, de Matteo V, et al. Nonunion and complication rate after percutaneous versus open first metatarsophalangeal joint arthrodesis: a proportional meta-analysis. Orthop Traumatol Surg Res. Published online January 12, 2026. doi:10.1016/j.otsr.2026.104588
‍
Roukis TS. Nonunion after arthrodesis of the first metatarsal-phalangeal joint: a systematic review. J Foot Ankle Surg. 2011;50(6):710-713. doi:10.1053/j.jfas.2011.06.012
‍
Gaudin G, Coillard JY, Augoyard M, et al. Incidence and outcomes of revision surgery after first metatarsophalangeal joint arthrodesis: Multicenter study of 158 cases. Orthop Traumatol Surg Res. 2018;104(8):1221-1226. doi:10.1016/j.otsr.2018.08.011
‍
Migues A, Calvi J, Sotelano P, Carrasco M, Slullitel G, Conti L. Endomedullary screw fixation for first metatarsophalangeal arthrodesis. Foot Ankle Int. 2013;34(8):1152-1157. doi:10.1177/1071100713483113
‍
Sharrow CM, Elmore B. Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Clin Sports Med. 2022;41(2):263-280. doi:10.1016/j.csm.2021.11.010
‍
Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus?. J Foot Ankle Surg. 2023;62(5):905-911. doi:10.1053/j.jfas.2023.04.015