Big Toe Joint Fusion

Stiffness caused by arthritis in the big toe is quite common in people over 50. Sometimes the big toe may have turned towards your second toe and a sore, red bunion has formed. This condition is usually familial and more common in females. Wearing tight fitting shoes can also contribute to the formation of a bunion. Sometimes your second toe may also change position and lie above or below the big toe.

Joint fusion involves removing the joint surfaces from each side of the big toe joint and then holding the bones together while they knit to become one. The bones are held together by screws or a plate, which are buried and not removed unless they cause problems. Following surgery, the toe is left slightly shorter than before but should be pain free and straight. The surgery can be performed under local or general anaesthetic.

The foot will be heavily bandaged, and you will be given a special shoe to wear over your bandage which must be worn whenever you walk about. The shoe can also be worn in bed to keep the weight of the sheet off your toes.

For the first 48 hours you should rest with your legs elevated above hip level in bed or a chair. It is important to perform anti-DVT (deep vein thrombosis) exercises 15 times every 30 minutes, whilst resting in bed or a chair. * See DVT symptoms in general post operative information. You will be given two compression stockings (so you can alternate them daily) to wear on your other leg. These need to be worn until normal mobility is resumed. One should be kept on during the day and removed at night; use the spare the next day after your bath or shower.

Most people will experience some discomfort as the local anaesthetic wears off. It is recommended that the pain-relieving medication given to you is taken before the local anaesthetic wears off and then regularly at the recommended dosage for the first two to three days.

Ice packs (a proper ice pack or frozen peas wrapped in a tea towel) will also help with discomfort. These can be applied for 10 minutes every two hours, but not directly onto the skin or on top of the dressing but on your shin above the bandage.

When you start walking around after your operation you should always wear your special shoe and use crutches if they have been issued. It is important you follow the guidance provided to you following your procedure.

Bleeding is more likely to happen in the first few days after your operation, especially if you are walking on it too much. If you notice any blood seeping through your dressing, wrap a clean towel on top of the dressing and put your foot higher than heart level and call your GP or 111 for advice.

After an operation you will have a surgical wound where the surgeon made a cut into your skin and tissue. It is important you take good care of your wound to lower your risk of infection and ensure it heals. You will be given advice about this on the day of surgery. Keep your dressing dry (do not remove or adjust it) and do not get your feet wet. You can buy waterproof protection sleeves which will enable you to bathe or shower as normal. The bandages will be left on for two to six weeks and you will be given an outpatient appointment to have them removed in our Outpatient clinic.

Most surgical wounds will heal without causing you any problems. A wound infection can develop at any time from two to three days after surgery until it heals. Very occasionally, an infection can develop several months after an operation.

Look out for these signs and symptoms of infection:

• Heat around wound.
• Increased pain.
• Wound discharge.
• High temperature.
• Generally feeling unwell.

If you have any of the above symptoms, please contact your GP or dial 111.

You will be able to return to work from two to six weeks after the operation, depending on whether you need to stand or walk a lot in your job. We can give you a Statement for fitness form if your employer requests one.

Please remember it is an offence to drive a vehicle while restricted by a post-operative boot or shoe.