Big Toe Joint Arthritis

Forefoot and toe pain can significantly impact mobility, balance, and overall quality of life. When conservative treatments are no longer effective, surgical options may be recommended to correct deformities, restore function, and relieve persistent discomfort. 

One of the most reliable procedures for advanced big-toe joint arthritis or deformity is first metatarsal-phalangeal (MTP) joint arthrodesis—a forefoot reconstruction and fusion surgery that stabilizes the big-toe joint by permanently joining the base of the big toe to the first metatarsal. This procedure helps eliminate pain caused by arthritis, injury, or congenital deformities and often improves the ability to walk comfortably, even in regular shoes.

During the surgical procedure, your podiatric surgeon will ensure that the top of your foot is clearly visible and that you won’t experience any pain. The incision will be made above the MTP joint, and any cartilage between the bones will be removed. During this time, any misaligned bones will be realigned.

Then, to hold the toe in place, metal pins or screws are used. The big toe is then slightly angled upward to help with pain while walking. A bone graft may be necessary around the joint to facilitate fusion. A metal plate may also help stabilize the toe by being placed around the joint.

Once the procedure is complete, the incision will require surgical staples or sutures and will be bandaged with a special splint or half cast. You might also need to wear a wooden-soled shoe or a moving cast for about 6 weeks. The total recovery time is expected to be between 6 and 9 months.

Arthrodesis of the first MTP joint is typically recommended for patients whose forefoot pain, joint deformity, or arthritis has progressed to the point where everyday activities are difficult or painful. If conservative care has not provided lasting relief, this procedure may offer a stable, long-term solution.

You may be a candidate for arthrodesis surgery if:

• You have advanced arthritis in the big-toe joint, causing chronic pain and stiffness
• Your joint deformity prevents normal movement or makes shoe wear uncomfortable
• Non-surgical treatments have not improved symptoms
• Pain limits your daily activities, including walking, exercise, or standing
• The joint is unstable or misaligned, affecting balance or gait mechanics
• You experience significant discomfort even during low-impact activities

If forefoot pain, big-toe stiffness, or joint deformity is limiting your mobility or making everyday activities increasingly difficult, it may be time to explore whether arthrodesis or another forefoot procedure can provide lasting relief. Surgery is never the first step—but when conservative care is no longer enough, a well-planned surgical approach can restore comfort, stability, and confidence in every step.