Fusion of the main joint of the hallux is the gold standard treatment for patients who have severe pain from hallux rigidus. The position the toe is fused in is critical. A flat surface is used in theatre to check that your hallux will be on the floor when you stand and also not digging into the 2nd toe. The next joint down (IPJ) will have stretched out to accommodate the stiffness of your hallux rigidus. Once the hallux 1st MTPJ is fused the mobility of that IPJ will allow you a normal gait (without the pain of hallux rigidus).

What can I expect on the day of surgery?

  • The surgery will normally be under a general anaesthetic.

  • Normally this is a day surgery case but some patients stay overnight.

  • I will numb the ankle and foot with local anaesthetic so that you will be comfortable when you wake.

  • There will be a plaster backslab on your foot and ankle which you will keep dry and intact for 2 weeks

  • You will be given crutches and shown how to walk with crutches, without putting weight on the leg

  • You will be shown how to inject your blood thinners

What are the risks and complications?

The vast majority of patients do extremely well. One patient in twenty has a non-union of the fusion which if painful requires repeat fusion. Rare complications include infection, DVT, nerve damage, CRPS, fracture, stiffness, recurrence, deformity, & ongoing pain in other parts of the foot.

Clear Advice About DVT

A DVT is a Deep Vein Thrombosis or a blood clot in the leg. A blood clot occurs after this forefoot surgery for about 2 in every 100 patients. You can help prevent a blood clot by keeping your knee moving. Keeping yourself hydrated is also helpful to prevent a DVT. Finally elevating your leg to the level of your heart will minimise the amount of swelling you have which will also help to prevent a DVT.


If you were the misfortunate patient who developed a DVT you would likely have some symptoms:

  • The leg (above the dressing/foot) would become hard, heavy, swollen, painful and/or red

  • If you were to have any of the above symptoms you would have to have a scan to look for a blood clot and then be treated with blood thinners

If the blood clot were to move to the lungs you would have a pulmonary embolism which is a medical emergency

  • The symptoms of a pulmonary embolism are breathless & chest pain- Call 911

When can I drive?

The best guide that you are safe to return to driving is that you are able to walk well without crutches in a normal shoe. The usual time scale also depends on whether you had surgery on your right or left foot and whether you drive a manual or an automatic.

  • Right side surgery and all car types: 6-8 weeks

  • Left side surgery and manual car:     6-8 weeks

  • Left side surgery & automatic car:     2 weeks

How long will I need to off work?

The time you require off from work depends on what type of job you do. The first two weeks of healing are critical and so you must have this time off work. Many people are able to work from home and so if you avoid commuting in the first six weeks, you will find that your foot does better. If you work on your feet all day, do a manual job, or are required to wear dress shoes you may need 8 weeks before you are back at work.

What instructions will I have for the first 2 weeks after surgery?

  • Elevate leg to above level of heart

  • Keep foot plaster dry for 2 weeks

  • Keep plaster intact

  • Move knee

  • Mobilise with crutches without putting weight on the leg

  • Take Vitamin D (25ug) and ensure good sources of Calcium in Diet (yoghurt, cheese, milk, oily fish, dark green vegetables and fortified cereals) and do so for the first 3 months after surgery

  • Avoid using anti-inflammatory medication like Ibuprofen regularly as this can prevent bone healing

What happens at 2 weeks in clinic?

  • You will attend my foot & ankle clinic to check your wound

  • If you have had very strong bone in theatre, I will advise you that you can start to weight bear in a removable walking boot

  • If you had a complex fusion, such as a lengthening fusion, I will advise you that you require plaster for another 4 weeks

Physiotherapy and instructions for the period from 2 weeks to 6 weeks following surgery

  • You must use the AirCast Boot whenever you are standing and walking

  • The boot may come off at night and to bathe the foot

  • You may bathe the foot provided you do not have K-wires in your toes

  • If K-wires, clean foot with a moist flannel but do not wet the wires

  • Wound massage with Bio Oil

  • Contrast bathing in hot and cold bowls of water (If no K-wires)

  • Gradually increase the amount of weight you put through the foot in the aircast boot and gradually put less weight through your crutches

  • Most patients only have one crutch by the time they come back to clinic at 6 weeks

  • Gradually increase the amount of time you spend standing and walking

  • Continue to elevate your foot when it is swollen

  • You may do pilates exercises/ abdominals and core (but only those where you are laying on a floor mat and no standing exercises)

  • Also stretch gastrocs, & hamstrings with theraband or towel wrapped around foot

Clinic Appointment 6 weeks following surgery

  • You will have a set of weightbearing radiographs

  • If you have K-wires in any of your toes these will be removed

  • Once the K-wire site has had a day to heal over you will be able to start wetting the foot

  • Gradually increase the amount of time you spend standing and walking

  • Continue to elevate your foot when it is swollen

  • You will then be able to go into a roomy lace up shoe

  • Work on walking slowly, heel through to toe off so that you are using your foot well

Physiotherapy and instructions 6 weeks+ following surgery


The Surrey Stages is a Foot & Ankle Rehabilitation Program designed to continue to strengthen the healing tissues while preventing injury as healing takes place




  • You can go up and down on tiptoes in sets of 3, slowly and 15 reps in each

  • You are working towards a normal gait (perhaps slightly slower to start)

  • All pilates exercises & gym equipment with foot plate (bike, rowing machine, X-trainer)

  • Note: If you and your physio are struggling to help you progress past the bronze award, start to wear a backpack and slowly increase the weight/ number of books in the back pack. Eventually you will be able to discard the back pack and progress to the Silver Award




  • You go up on both feet but lift unoperated leg and lower slowly only on operated leg

  • 3 sets, working to 15 reps in each

  • You can stand both feet on a wobble board

  • You can hold a solid DHR for 20 seconds

  • You can skip on the spot (low height) with both legs




  • 3 sets, working to 15 reps in each

  • You can stand on one foot on wobble board

  • You can hold a solid DHR for 40+ seconds

  • Very gentle jogging


BOFAS Registry

All First MTPJ Fusions are entered into the UK data base held by the British Orthopaedic Foot and Ankle Society

The consent form is below