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The response to the question below was authored by Marc Mitnick DPM

Post op big toe fusion

by Gill

fusion of big toe joint

fusion of big toe joint

fusion of big toe joint
Max I can bend top joint
elevated toe from joint fusion


I had a toe fusion on my right big toe 12 weeks ago. I still have pain (and irritation from rubbing on the wound) when walking in shoes, and my toe in it's (normal) position post op is about an inch off the floor, so even when I bend my top joint it won't touch the floor.

Is this normal, as I'm beginning to regret having the op done?

I had osteoarthritis in the toe joint and this was the only option I was given to 'cure the pain'


Hi Gill,

If you have done much reading on my site, you will find that I am not a big fan of great toe joint fusions. Although they are done quite frequently, there are inherent problems with them.

I wish I knew how old you are as my criteria for doing them is very limited. In general the younger you are, the less inclined I would be to offer that type of procedure. There are certainly alternative procedures that could have been offered.

The problems I have with this type of procedure is partly explained by your complaints as seen in your pictures.

Since the joint is being fused and thus will not allow any movement (and therefore resolve your pain) the big toe has to be angled in a manner relative to the metatarsal bone so that you can actually walk on your foot.

The toe is fused in an elevated position to allow you to "roll" off the great toe when you walk. If the toe was planted on the ground, you would not be able to "roll" off
the toe and thus would have difficulty in walking.

If you happen to be relatively young and are athletic, this new position of the toe may or may not impede your ability to be athletic.

The other problem is that any time you fuse a given joint, that automatically puts additional stress on the adjacent joints and can cause pain down the road with those joints. Because the big toe joint is fused and that changes your gait, it creates compensation of the adjacent joints.

If you are an older individual and more sedentary this may not be as big an issue as opposed to being younger and more active.

You mention this procedure was done for osteoarthritis of the big toe joint and that is certainly a criteria for this type of procedure, but there are other procedures that may have been available to you. Naturally I would have to examine you and see x-rays to make any suggestions, but at this point it is water under the bridge.

So, at this point in time, if you can accept the fact that your toe is raised off the ground, you may find as time goes on that you will be able to function fairly well with your toe in its new position. You may have to change the shoes you are accustomed to wearing and will have to look for low heels with a high toe box (room in the front part of the shoe to accommodate the raised toe).

Most surgeons would suggest to you that if the procedure eliminated your pain, then it was a successful procedure.

Marc Mitnick DPM

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Nov 09, 2019
Pain always
by: Joyce

I had the same thing done 18 months ago. Also with a staple in the second metatarsal joint which I think is broke...I still have severe pain in walking . only now in a new place because of the way I have to walk. Consist burning in the side of the foot. I was very active. Avivid Walker and now cant go an hr and basically stopped me from being active....Numerous dr have said it will get better and its not. I dont recommend this surgery to anyone unless u have no other options. I'm 52 and scared I will be like this for the rest of my life...

Oct 29, 2019
Toe fusion 5 month post op
by: Julie cuthcert

I had a big toe fusion in May , I am still suffering a lot of pain in the smaller joint ... The large joint was the only part he operated on even though I told him I actually had more pain in the smaller joint .. Hence why I'm left with pain only worse now than before operation ... A colleague of his told me there's options if it doesn't get better, but never said what ... I would really appreciate any advice thank yoi

Hi Julie,

When you say smaller joint, I am assuming you are referring the joint that actually makes up the big toe (it would be the joint in front of the joint that was fused)

Your doctor should have listened to you, as perhaps the big joint did not need to actually be fused.

In any event you can try some conservative treatment, if it has not already been done. The first thing I would do would be to give you a cortisone injection into the smaller joint. If that does not sit well with you, you could try a round of anti-inflammatory medication along with some physical therapy.

You might also try limiting your shoes to those with stiff soles. The stiffer the sole, the less stress placed on the toes.

If none to that works out for you, then you may have to entertain surgery on the smaller joint.

Marc Mitnick DPM

Dec 04, 2017
Big toe off the ground
by: Ignacio

Hi Gill, I had the same problem and operation. And also my toe is off the ground. I suffer not only from rubbing the toe with my shoes but also pain in the toe itself and transfer metatarsalgia in toes 2, 3 and 4.A surgeon is suggesting to re-do the fusion, placing the toe in a plantar flexed position and also shortening toes 2 and 3. My question is if you ever did something to fix your issues and what was it (and whether it worked or not). Thanks

I would be careful about having a second fusion. The toe is supposed to be elevated so that you can "push off" it when you ambulate. Putting the toe in a plantarflexed position will make it more difficult to walk (but the toe will not rub on your shoe), not much of a trade off.
As for the metatarsalgia, why not try an orthotic first before going thru further surgery.

Marc Mitnick DPM

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