Big Toe Fusion surgery

Yes, big toe fusion (arthrodesis) can be performed on younger individuals, but the decision to undergo this procedure depends on several factors, including the severity of the arthritis, the level of pain, the impact on daily activities, and the failure of other non-surgical treatments.

Considerations for Big Toe Fusion in Younger Patients

1. Severity of Arthritis: If the arthritis is severe and significantly impacts quality of life, fusion might be considered despite the patient's age.

2. Non-Surgical Treatments: Before opting for surgery, it's crucial to exhaust non-surgical treatments such as medications, orthotics, physical therapy, and activity modifications.

3. Pain and Functional Impairment: If pain is debilitating and significantly limits daily activities or participation in sports, surgery might be necessary.

4. Activity Level: Younger, more active individuals may initially prefer joint-sparing procedures to maintain joint movement, but if these fail, fusion may become a viable option.

5. Long-Term Outcomes: Fusion provides long-term relief from pain but results in a permanent loss of motion in the joint. Younger patients need to consider how this will affect their lifestyle and activities.

6. Alternative Surgeries: In younger patients, other surgical options such as cheilectomy (removal of bone spurs) or osteotomy (realignment of the bone) might be considered first to preserve joint movement.

Benefits of Fusion

• Pain Relief: Fusion typically provides significant and lasting pain relief.

• Stability: Creates a stable and strong joint.

• Durability: Usually a permanent solution, eliminating the need for future surgeries related to arthritis in the fused joint.

Risks and Downsides

• Loss of Motion: Complete loss of movement in the big toe joint.

• Altered Gait: May affect the way a person walks or runs.

• Activity Limitations: Some activities, especially those requiring toe flexibility, might be more challenging or uncomfortable.

Evidence

A study comparing fusion in young (<50 years) compared to older individuals found that fusion did very well and was as successful for the patients in the younger age group as it was in the older age group at 14 years post surgery.

Wearing heels after a first metatarsophalangeal joint (MTPJ) fusion can be challenging due to the loss of joint mobility and changes in foot mechanics. Here are some considerations:

Post-Fusion Foot Mechanics

• Loss of Flexibility: The fused joint will no longer bend, which can make it difficult to wear heels comfortably.

• Altered Gait: Walking in heels requires significant toe flexion, which is not possible after fusion, potentially leading to discomfort or instability.

Recommendations for Wearing Heels

1. Heel Height: Lower heels (typically 1-2 inches) are more manageable than higher heels. Higher heels can increase pressure on the forefoot and fused joint, leading to discomfort.

2. Gradual Transition: Gradually increase heel height to allow your foot to adapt. Start with very low heels and see how your foot tolerates them.

3. Custom Orthotics: These can provide additional support and comfort when wearing heels.

4. Special Occasions: Reserve wearing heels for short durations and special occasions rather than daily use.

Practical Tips

• Listen to Your Body: Pay attention to any discomfort or pain. If wearing heels causes significant discomfort, it’s best to avoid them.

• Alternate Footwear: Switch between different types of shoes to avoid prolonged pressure on any one part of the foot.

Alternative Fashion Options

• Wedges: Low wedges can offer a compromise between style and comfort, providing a bit of height without excessive pressure on the forefoot.

Long-Term Considerations

• Foot Health: Prioritize the long-term health of your foot. Continual stress on a fused joint from inappropriate footwear can lead to other complications or discomfort.

• Lifestyle Adjustments: Adjust your footwear choices to align with your new foot mechanics post-fusion, ensuring comfort and mobility.

Overall, while it might be possible to wear low heels occasionally after a first MTPJ fusion, it's essential to prioritize comfort and foot health to avoid complications.

Evidence

A study found Of the 42 patients who wore heeled footwear pre-surgery, 26 (62%) continued wearing them. The majority of them (n = 23, 88%) were able to wear the same height heels. Patients could use heeled footwear from 30 min to eight hours continuously (mean=3 h) and, 88% were able to wear heel heights of 1.5 in. or higher. 

Yes, you can still participate in sports after a first metatarsophalangeal joint (MTPJ) fusion, but your ability to engage in specific activities may be influenced by the loss of joint mobility and the type of sport. Here are some key considerations:

Types of Sports and Activities

1. Low-Impact Activities: Generally more suitable post-fusion.

o Swimming: Does not put stress on the feet.

o Cycling: Minimal impact on the fused joint.

o Rowing: Focuses on upper body and core, reducing stress on the feet.

o Yoga and Pilates: Can be adapted to accommodate the fusion.

2. Moderate-Impact Activities: May be possible with adjustments.

o Walking and Hiking: Comfortable shoes and possibly orthotics can help.

o Golf: Generally manageable, but consider using a cart if walking long distances is uncomfortable.

o Weightlifting: Most exercises can be performed, but be cautious with movements that heavily involve the feet.

3. High-Impact Activities: More challenging but not necessarily impossible.

o Running: Some individuals may return to running with proper footwear and technique adjustments, though it can be difficult.

o Tennis and Racquet Sports: Quick lateral movements can be challenging, but playing on softer surfaces may help.

o Soccer, Basketball, and Similar Sports: High-impact and quick changes in direction can be tough on the fused joint.

Tips for Engaging in Sports Post-Fusion

1. Footwear: Invest in high-quality, supportive shoes tailored to your sport. Custom orthotics can provide additional support.

2. Activity Modification: Modify activities to reduce stress on the fused joint. For instance, avoid high-impact jumping or rapid direction changes.

3. Strength Training: Focus on strengthening the muscles around your foot, ankle, and leg to compensate for the lack of joint movement.

4. Flexibility Exercises: Maintain flexibility in the surrounding joints and muscles to improve overall foot function.

5. Gradual Return: Slowly ease back into sports, gradually increasing intensity and duration to allow your body to adapt.

Evidence

A recent review article reviewed ten articles with 450 patients. For sporting activities reported by multiple studies (running, yoga, golf, hiking, tennis, elliptical, and biking), 10-30% of people stated that it become easier to do sporting activity after 1st MTPJ fusion, 70-90% of people said that sporting activity remained the same, and 2% to 9% of patients said that it become more difficult to do sporting activity after first MTP fusion. One article reported return to sport after fusion to be 12 weeks ± 5 weeks.