1st MTP Fusion Claw Toe
ANIMATED VIDEO: Dr. Desai uses the Arthrex First MTP set for the open first MTP joint procedure
Day of Surgery
Please refer to: Preparing for Surgery for full details on what to expect the day of surgery.
Right before surgery, you will be taken to the “block room” prior to the operating room. You will get a local nerve block by the anesthesiologist. A nerve block is local anesthetic (freezing) that will be injected around your nerves which freezes your leg. This is done under ultrasound guidance which ensures accuracy and safety. The nerve block avoids requiring a general anesthetic (GA) which requires a full intubation. You will still be given some medication to make you sleepy so you won’t hear, feel or remember anything.
If you prefer not to have a nerve block, or you have had a negative experience with a previous anesthetic, you will be able to discuss this with the Anesthesiologist prior to surgery. They will work with you to address your needs and anesthetic preferences.
The First 24 hours
The first 24 hours after surgery to me is the most important part of your recovery. The nerve block lasts around 12 hours or so. Therefore, in the middle of the night the nerve block will wear off and the pain will start. This is why I recommend starting your pain medications prior to going to bed. By starting your pain medication before the pain starts you have pain medication in your system as the nerve block wears off. This helps block your body’s pain response from ever happening. Nine out of 10 patients who follow these specific instructions have nearly no pain throughout their entire recovery.
You will be getting a prescription for Dilaudid (hydromorphone) which is a narcotic medication. If you have an allergy to this, I will give you a different medication. I recommend taking the Dilaudid before you go to bed. I recommend taking it every six hours. I also recommend taking Tylenol (acetaminophen) and Advil (ibuprofen) together every six hours. I recommend that you stagger these medications. For example, if you go to bed at 9 PM, take your Dilaudid, three hours later at midnight, take Tylenol and Advil, three hours later, take your Dilaudid again, etc:
This seems like a lot of medication, but all three medication’s work in very different ways to help manage pain. It is safe to take all three. I want you to have a good experience throughout your entire surgical journey and how do you manage your medication’s directly after surgery is extremely important to making sure you have a good overall recovery.
I would recommend you follow these instructions taking these medications for the first 48 hours only. After the first 48 hours, you can then just take Tylenol and Advil every six hours. Most patients are off all their medications within 2 to 3 days.
I will provide you with more than enough narcotic medication for your surgery. You will most likely not use all the pills provided. I always give a few extra in case. I do not provide refills for narcotics under any circumstance. In the rare circumstance you still have pain after 48 hours, I recommend taking Tylenol and Advil.
First 2 Weeks After Surgery
Pain:
After the first 24-48 hours you most likely will not require any pain medications. You may need the occasional Tylenol and/or Advil.
Devices:
After surgery you will be placed in a sandal and a dressing.
Wound/Dressing:
The dressing and sandal will remain until you see me back in clinic in 2-3 weeks post operatively.
You can remove the sandal when you are not walking (i.e. sitting, sleeping, etc.); however, most patients feel more comfortable leaving the sandal on at all times as it protects the surgical site.
Do not get your boot wet. Use a bag or cover during your showers.
Weight Bearing:
You may heel weight bear immediately (for 6 weeks total).
Activity:
Please limit your activity. I would recommend doing your daily activities at home, but I would not recommend any significant activity, long walks, etc. as significant swelling may occur which will be painful and slow your overall recovery.
Light workouts are permitted, but remember, if you work out and sweat your surgical site would sweat as well so keep that in mind.
2 to 6 Weeks After Surgery
Appointment:
At your first post operative appointment (usually 2-3 weeks after surgery) we will remove your dressing and stitches.
Devices:
Sandal: The sandal is used at all time with walking for the first 6-weeks. You may remove the sandal when you are not walking. Some patients prefer to leave the sandal on at all times to protect the surgical site but this is not mandatory.
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your foot and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate. I recommend using the “Hand and Wrist Wrap” which works between for forefoot surgery than the “Foot and Ankle Wrap”.
Wound/Dressing:
We will place small bandages called steri-strips. You may begin taking showers immediately; however, I do not recommend immersing the wound in water (bath, hot tub, pool, etc.) for 6 weeks total from the time of surgery. The steri-strips will slowly peel off themselves. There is no need to pull them off or replace them when they do fall off.
Do not place any creams/lotions etc. for 6 weeks.
Weight bearing:
You may heel weight bear (for 6 weeks total).
Activity:
Please limit your activity. I would recommend doing your daily activities at home, but I would not recommend any significant activity, long walks, etc. as significant swelling may occur which will be painful and slow your overall recovery. In general, walking up to 5,000 steps per day is permitted if you have minimal pain and swelling.
You may start exercising (upper body exercises and core exercises).
Therapy:
I recommend starting some range of motion exercises of the big toe. Perform up and down movement (dorsiflexion and plantarflexion) 3 times a day for 10 repetitions each. You may also use your hand to move the toe up and down. The purpose of this movement is to avoid stiffness of the toe.
6-12 Weeks After Surgery
Appointment:
At your 6 weeks post-operative appointment, X-rays will be taken to assess healing.
Devices:
Sandal : You may wean off the sandal and start using your regular shoe. You may still have some swelling so you may need a large size shoe, or one that is more flexible.
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your foot and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate. I recommend using the “Hand and Wrist Wrap” which works between for forefoot surgery than the “Foot and Ankle Wrap”.
Compression socks: Compression socks are used after surgery in order to decrease swelling. Medical grade compression recommended – 20-30mmHg pressure. Starts between 6-12 weeks post-operatively. If you use a compression sock, you must use a toe spacer (up to six months post-operatively.
Activity:
You may slowly return to your regular daily activities including walking, exercise, etc. You may walk up to 10,000 steps per day.
I would avoid more strenuous activities such as running, jumping, sports, yoga, etc. The bone is only partially healed at this point. Therefore, you want to avoid overloading the toe during this stage of healing.
Therapy:
No formal therapy required:
12+ Weeks After Surgery
Appointment
Your 12-week appointment will be your last appointment
X-rays will be taken to assess healing.
Devices:
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your foot and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate. I recommend using the “Hand and Wrist Wrap” which works between for forefoot surgery than the “Foot and Ankle Wrap”
Compression socks: Compression socks are used after surgery in order to decrease swelling. Medical grade compression recommended – 20-30mmHg pressure. Starts between 6-12 weeks post-operatively.
Weight bearing:
You may fully weight bear.
Activity:
You may slowly return to your more strenuous activities such as running, jumping, sports, yoga, etc. You may experience some swelling as you return to your regular activities. A compression sock (see above) can be helpful.
Therapy
Continue to work on toe range of motion exercises: