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1st MTP JOINT FUSION

Arthritis is the loss of the cartilage, Teflon-like coating, on the ends of the bones.  As this smooth surface erodes, the joint becomes swollen and painful.  Arthritis is most frequent following some injury, but can also be seen due to wear and tear and with rheumatoid arthritis.  Initial treatment may involve medications, such as glucosamine and anti-inflammatories.  Other options include shoe modification, such as rigid shoe or carbon insert, and activity modifications.  In more severe cases, a fusion is required.  During surgery the arthritis is removed and the bones are permanently held together with screws and a plate.  This surgery is performed as an outpatient.  The surgery is generally very successful at eliminating the pain.  You will have some swelling for six to nine months following surgery, this is normal.

As with any surgery there are risks, these include infection, bleeding, numbness, and a chance of a non-union (the bones do not fuse together).  We try hard to make your surgical experience as pleasant as possible and have found the following points helpful.

  1. We use a re-circulating cold water unit called a “polar pack”.  Mark with Pacific Medical will contact you before the surgery date and have you pick this up.  Bring this with you to the surgery as it will be applied during surgery.  The polar pack helps greatly with decreasing swelling and decreasing the pain.  Turn the polar pack off every two hours for 15 minutes to prevent your foot and ankle from becoming too cold.
  2. Elevation will help with pain and swelling.  You need to elevate your foot above your left shoulder constantly for the first 72 hours and then frequently the first 10-14 days.
  3. You will be in a bunion shoe following surgery.  You need to wear this 24 hours a day for the first 10 weeks following surgery.
  4. You will have a moderate amount of bleeding the first night of surgery; this is normal.  We see you the following day for a dressing change.  You will have another appointment 10-14 days following surgery, we will obtain x-rays and remove the sutures at this time.  You need to keep your foot dry until this appointment.  You will have another appointment at five weeks from surgery for a clinical check and again at 10 weeks for x-rays.  At that time you are allowed to wean into a regular shoe as pain and swelling allows.
  5. You will be non-weight bearing for the three weeks following surgery and then you may weight bear as pain allows.  So you will need to obtain crutches or a rollabout prior to surgery.  A list of suppliers is attached.
  6. In order to minimize pain after surgery, we generally use regional anesthesia, called a popliteal block, you will have no pain for 6-18 hours after surgery.  During this time your foot and ankle will be numb and will not support you.  In addition, it is important that you begin your pain medication before this block wears off as to get the medication in your system and working.  Generally we recommend you start the pills the evening of surgery and then set your alarm clock to awake during the first night to take the pills to help control the pain.  Then you may take them as needed for pain.  Below are listed the common medications and their dosages:

If you have questions or concerns please feel free to contact your physician's nurse at 323-2600.

 

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