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1st MTP JOINT FUSION with CLAYTON PROCEDURE

Rheumatoid Arthritis can cause inflammation and swelling in the foot.  This process can lead to dislocation of the joints in the foot and subsequent painful prominences on the bottom of the foot.  Initial treatment options include shoe modification, such as inserts, shoe stretching or silicone inserts and activity modifications.  In more severe cases, a fusion is required of the great toe and straightening of the other toes.  During surgery the arthritis is removed and the bones are permanently held together with screws and a plate on the great toe.  With the smaller toes the joints are removed and pins are placed while the bones are healing.  This surgery is performed as an outpatient.  The surgery is generally 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 some 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 may possibly remove the sutures at this time.  In most cases, we will leave the sutures in place for 3 weeks as there is delayed healing with rheumatoid arthritis.  You need to keep your foot dry until the pins are removed.  You will have another appointment at six weeks from surgery for a clinical check and the pins will be removed at this visit in the office.   Your next appointment will be at 10 weeks from surgery 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 first 3-6 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 so 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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