On the Day
After the anaesthetic has worn off your foot should be largely free of pain, due to the use of nerve blocks. You will be given a course of pain killers and anti inflammatory tablets. These will be working for you when the nerve blocks wear off by 12 hours or so.
This will be in a post-operative bandage ( Dgx1). Generally we avoid using plaster casts. If the bandage feels too tight it can be gently loosened.
You should keep your foot elevated as much as possible when resting for the first 48 hours. Try to avoid letting it hang down when sitting and put up on a pillow or two at night.
A physiotherapist will instruct you on the use of crutches and your post operative shoe (dgx1). Generally you may put as much weight through the foot as you wish, within what is comfortable, as long as you remain in your shoe for walking. In some cases such as revision surgery or if your bone is soft your surgeon may advise you just to put weight through your heel.
At two weeks
You will require an outpatient assessment and wound review. Your bandage will be removed and you may now get your wound wet (shower, bath ect). Occasionally non absorbable sutures are used and these will be removed.
You will still require your post-operative shoe .
You will be shown excercises to help the remaining joint of the big toe .
At six weeks
You will require an outpatient assessment and check x-ray to confirm fusion has occurred. Usually you will be able to go back into normal shoes at this stage.
Chance of success
The chance of a successful fusion occurring is approximately 95%. This is likely to be reduced if you smoke.
I still don't like the sound of a big toe fusion, what about a big toe replacement?
Replacement of the big toe has a long though not yet satisfactory history, certainly twenty five years. No previous/established implants have succeeded in being able to maintain movement whilst preserving good mechanical forefoot function and being predictably long lived. Given this we cannot recommend ,and do not use, an implant which has been in widespread use.
We are currently involved in a multi-centre trial of a new big toe joint replacement.
The situation in which there would be little argument about using a replacement is shown by the following X rays. Here there is arthritis at both toe joints .A fusion of the larger joint ,if required, is likely to lead to increasing pain from the remaining (and compensating) IP joint.
A case for replacement