The Center for Podiatric Care and Sports Medicine

Big Toe Fusion Surgery: All Your Questions Answered

Posted by on Friday, September 7th, 2018


During a big toe pain consultation at The Center for Podiatric Care and Sports Medicine, we may determine you need a fusion of the big toe. Admittedly, the images it conjures up for patients can be scary at first! We’ll do our best to dispel some of the common myths, answer any questions you may have, and reassure you that big toe fusion surgery isn’t as scary as it sounds.

big toe fusion surgery
We’ll do our best to dispel some of the common myths, answer any questions you may have, and reassure you that big toe fusion surgery isn’t as scary as it sounds. [Image Source: Unsplash user ninoliverani]

What is big toe fusion surgery?

Big toe fusion surgery is done to stiffen the first metatarsophalangeal joint, where the base of the toe connects to the foot. Bony bumps and arthritic deformity are corrected with this procedure. Most of our big toe surgery patients have been diagnosed with late-stage hallux rigidus where joint replacement cheilectomy is not warranted or with rheumatoid arthritis that has severely damaged the joint. In rare cases, we employ a big toe fusion to correct severe deformities like bunions if more conservative measures are not effective. We have also seen big toe fusions treat complications from other operations when the toe is weak, painful, or deformed.

Are there contraindications?

Anyone who is medically fit can have a fusion surgery. Patients with medical problems like diabetes, high blood pressure, circulatory issues, or asthma may require additional tests to be sure they are surgery-ready. These patients may require closer monitoring and an overnight stay. Smokers and heavy drinkers who continue tobacco and alcohol use during the healing period are more likely to suffer complications like delayed healing or nonunion.

Will I be awake during big toe fusion surgery?

The operation is routinely done under general anesthesia, but can be done with a local anesthetic and a mild sedative. People who want to be less drowsy, forego some of the unpleasant anesthesia side effects, and get back to eating, drinking, and exiting the facility sooner may choose this option. Local and general anesthesia are often used in conjunction to reduce the pain long after the patient awakens from surgery. Painkillers are also prescribed.

How is big toe fusion surgery performed?

During the surgery, a cut is made along the side of the toe, where the joint can be opened. Bony lumps are trimmed. Joint surfaces are smoothed and trimmed to fit into proper position. Two screws or a small plate are used to hold the new angle. After stitching you up, a dressing is applied and you’re sent on your way once you are comfortable—no hospital stay necessary.

Will I need a cast or boot?

Plaster casts are not necessary to heal from surgery unless your operation required a lot of soft tissue repair as well. Extra protection may be needed for bone graft operations for short floppy toes. Rarely, these patients will need six weeks of immobilization. More routinely, patients find they are most comfortable in a protective sandal with a stiff sole or a special surgical shoe. It could take up to six weeks for the swelling to go down enough to fit into your regular shoes again.

What else does big toe fusion recovery entail?

You will need to take it very easy for the first two weeks and avoid walking as much as possible. Keep your foot elevated whenever you are at rest to reduce swelling. When you need to get around, walk on your heel, using crutches for added support. You may want to wear an immobilizing splint that can be removed for bathing. It’s especially important to keep the bandages totally dry during the first two weeks, so you may want to use a waterproof cover to shower.

How often will I need to see the doctor after big toe fusion surgery?

A follow-up will be required within two weeks to remove the dressings, examine the wound, remove stitches (if necessary), and take an X-ray. The next clinic appointment will be scheduled four weeks out. At this meeting, we’ll likely tell you the splint is no longer necessary, although some patients need another 3-4 weeks with the splint if the fusion has not yet solidified. Your final appointment, X-ray, and discharge should take place about 12 weeks after surgery.

When can I go back to work?

Patients with desk jobs can get back to work in about three weeks post-op. If you drive for work, plan on taking at least six weeks. Getting back behind the wheel will take some adjustment if your pedal foot was operated upon. Those with busier, more manual labor can take up to three months. We provide each individual with a customized, realistic timeline for returning to work.

When can I return to sports?

Returning to sports will require some rehabilitation, stretching, and drills to get you back into shape. We can do all that right here at our NYC center. Everyone is different in how quickly they are able to return to exercise. Running, swimming, and cycling are the best activities to regain strength during healing. Most people are back to these activities within six months. Trust your body!

Are there complications with big toe fusion?

The worst case scenario is that your fusion will fail, which is the case in about 5-10 of 100 people. A “technical” failure, as evidenced by radiographic images, does not always constitute problems for the patients, however. Half of those with a big toe fusion failure will have no problem with pain or mobility, as the scar tissue often holds the bones together just as firmly.

Some patients will need a re-do, but the rate of failure of revision surgeries is higher (15-20 in 100 people, with 50% of those patients suffering ongoing pain). Increased risk of failure is observed in patients with diabetes, rheumatoid arthritis, poor circulation, and smoking habits. We will, of course, weigh all the pros and cons with you during your consultation.

Infections (1%) and minor damage to the nerves (5%) are risks with any surgery. These complications can be managed and resolved quickly with proper vigilance. You may be given blood thinning medication after surgery if you are at high risk for deep vein thrombosis (3%), although doing your recommended exercises and moving the ankle every so often can reduce your risk of this life-threatening condition as well.

What are the benefits of big toe fusion surgery?

You should notice a significant reduction in pain right away that continues to get progressively better over the next three months. Most patients are fully back to doing everything they love by the one-year mark, when all evidence of mild swelling disappears.

How will fusion surgery change my life?

You will notice some differences in your life following a great toe fusion. Your big toe will be stiffer than it once was. You may find you cannot wear heels above one-inch without pain or stiffness. Your walk may be a bit different, but if you’ve had severe arthritis, you’re probably used to an altered gait already. The comfort you receive is a welcome trade-off for most patients! Some patients elect to have a custom insole made for the shoes that enhance the comfort of all footwear even further.

Where can I go for big toe fusion surgery in NYC?

The Center for Podiatric Care and Sports Medicine in White Plains and Manhattan is a top source of foot and ankle care. Our staff is comprised of board-certified surgeons and state-of-the-art technology to rehabilitate our patients quickly and effectively, particularly if they are active athletes who want to get back to competition or other activities they love without delay. Contact NYC foot surgeons for a consultation if big toe pain is interfering with your quality of life.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.