Foot & ankle · Arthritis care

First MTP joint fusion in Canada

First MTP joint fusion is a definitive procedure for severe end-stage hallux rigidus (big toe arthritis), fusing the metatarsal and proximal phalanx for durable pain relief and a stable foundation for walking. Consultations with our fellowship-trained foot and ankle surgeons in 1–3 days, with surgery typically 2–4 weeks later. Protected weight-bearing in a post-op shoe is typical for 6–8 weeks while the bone fuses, with return to athletic activity at 4–6 months.

At Pathway, our fellowship-trained foot and ankle surgeons perform first MTP joint fusion. Consultations are available in 1–3 days, with surgery typically 2–4 weeks later.

Book a consultation (647) 799-3230
  • Designed for durable pain relief
  • Post-op shoe typically 6–8 weeks
  • Surgery in 2–4 weeks
  • No referral required
Patient tying supportive footwear after first MTP joint surgery recovery
5.0 from 250+ reviews
Low-profile titanium fixation

At a glance

First MTP joint fusion at a glance

First MTP joint fusion is a definitive procedure for severe end-stage hallux rigidus (big toe arthritis), fusing the metatarsal and proximal phalanx for durable pain relief and a stable foundation for walking.

1–3 days
to first consultation
2–4 weeks
from consult to surgery
6–8 weeks
protected weight-bearing in a post-op shoe
4–6 months
typical return to athletic activity
The procedure

The goal of big toe fusion.

Hallux rigidus, or severe arthritis of the big toe joint, can make every step painful. When the protective cartilage is gone and bone-on-bone friction occurs, joint mobility is lost and replaced by chronic inflammation and bone spurs.

First MTP joint fusion is intended to address this painful motion. By fusing the joint in a precise, functional position, the procedure allows you to roll over your foot during a stride without the sharp “catch” of an arthritic joint. It is a highly reliable procedure with high patient satisfaction.

When to consider fusion

Advanced hardware

Low-profile fixation.

We utilize specialized titanium plating systems designed to be exceptionally strong yet barely felt beneath the skin.

Anatomic plating

Modern plates are pre-contoured to match the anatomy of the first metatarsal. This allows for a “low-profile” fit that minimizes irritation from shoes while providing enough strength to allow for earlier weight-bearing.

Compression screws

A specialized screw is often used across the joint to provide maximal compression. This compression is intended to speed up the bone-to-bone fusion process and ensure a solid biological union.

Your surgeon

Our big toe fusion specialist.

Fellowship-trained surgeon expert in corrective foot surgery and joint fusion.

Dr. Danny Arora, big toe fusion surgeon

Dr. Danny Arora

Minimally invasive foot & ankle surgery · Duke University fellowship trained

Dr. Arora is Duke University fellowship trained in minimally invasive foot & ankle surgery, with expertise in corrective foot surgery and first MTP joint fusion.

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Earlier-stage arthritis?

For early- to mid-stage hallux rigidus, a minimally invasive cheilectomy removes bone spurs through tiny incisions while preserving your natural joint — often delaying the need for a fusion. Your surgeon will assess which option fits your stage of arthritis.

Learn about minimally invasive cheilectomy
FAQ

Frequently asked questions.

First MTP joint fusion (big toe fusion) is a surgical procedure that joins the bones of the big toe joint together. This is intended to stop painful motion in a joint that has been destroyed by severe arthritis (hallux rigidus) or significant deformity, providing a durable and stable result.

Fusion is typically the treatment of choice for end-stage hallux rigidus where the joint cartilage is completely worn away. Unlike joint replacement or 'clean-up' surgeries (cheilectomy), fusion offers the most predictable and long-lasting relief for patients with severe pain.

The joint is fused in a slightly upward position to allow your foot to 'roll' naturally during walking. Most patients find that their gait actually improves because they no longer have to compensate for joint pain. You can continue to walk, hike, and even perform light running.

Because the joint no longer bends, very high heels (above 1-2 inches) are generally not recommended as they place too much stress on the fusion site. However, most patients can wear formal shoes, sneakers, and comfortable flats without issue.

Patients typically use a specialized surgical shoe for 6-8 weeks to allow the bones to grow together. Full weight-bearing in regular sneakers usually begins around 2 months post-op, with full swelling resolution taking 4-6 months.

No referral is required. You can book a consultation directly with our surgical team to have your big toe evaluated and discuss whether fusion is the right option for your condition.

Next step

Start your care journey.

Schedule a consultation to discuss your big toe pain and explore whether first MTP joint fusion is the right long-term solution for you. No referral required.

Book a consultation (647) 799-3230
Related links

Continue your research.

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