1st metatarsophalangeal joint (MTPJ)
Indications for referral to surgery:
Conservative measures have been tried for 12 weeks including specialist footwear, orthoses and analgesia (+/-podiatry referral) AND the patient has:
- Persistent pain causing significant functional impairment*
- Moderate to severe deformity that prevents patients from finding comfortable footwear
AND patient willing to consider surgery
*Significant functional impairment is defined as a restriction or interference with an individual’s capacity to meet personal, social or occupational demands. Please state the impairment of the individual is experiencing.
If good movement and no dorsal impingement (painful mechanical limitation of full big toe range of motion secondary to a bone or soft-tissue abnormality) refer to podiatry
Patients undergoing 1st MTP surgery will need to be prepared to:
- Be off work for 6-8 weeks for sedentary work, 3-6 months for physical work
- Be unable to drive for 6-8 weeks (2 weeks not driving if left foot and automatic car)
- 1 in 10 people may be unhappy after any surgery
Imaging - Please include an up to date X ray with weight bearing views report within or attached to the referral. This includes for soft tissue injuries to exclude underlying pathology.
Referrals without up to date reports included and Xrays that are not weight bearing will be returned, unless there are mitigating circumstances why this is not possible
REFERENCES:
British Orthopaedic Association and Royal College of Surgeons England. Commissioning Guide Painful Deformed Great Toe In Adults, 2017.
Date reviewed 8/2/2022
Next review due 8/2/2023
Sifter name Dr Rebecca Hopkins
Version No. 1.1