Will a 1st MTP Fusion Limit My Activities or Change the Way I Walk?
If you have been told you may need a 1st MTP fusion, you may have some understandable concerns.
Will you still be able to walk normally? Can you exercise, hike, bike, or play sports? Will your foot feel stiff or cause you to limp?
The good news is that 1st MTP joint fusion, also called first metatarsophalangeal joint arthrodesis, is designed to relieve pain while preserving the overall function of the foot. Although the big toe joint is permanently fused, research shows that many patients are able to return to normal daily activities and an active lifestyle after healing.
In fact, multiple studies have found high levels of function, satisfaction, and return to physical activity following a successful 1st MTP fusion.
What Is a 1st MTP Fusion?
The first metatarsophalangeal (MTP) joint is the joint where the big toe meets the foot. This joint normally moves as you walk and helps your foot push off the ground.
A 1st MTP fusion removes the damaged cartilage and prepares the joint surfaces so the bones can permanently heal together in a carefully selected position. The goal is to eliminate painful motion at the arthritic joint while creating a stable, functional big toe.
First MTP fusion is commonly used for conditions such as:
Severe big toe arthritis
Hallux rigidus
Painful or recurrent bunions
Significant joint damage
Arthritis that has not responded to nonsurgical treatment
Certain deformities of the big toe
The important thing to understand is that only the 1st MTP joint is being fused. The goal is not to make your entire foot stiff. The ankle and the other joints in your foot continue to move normally.
Will a 1st MTP Fusion Change the Way I Walk?
For most patients, a successful 1st MTP fusion does not result in a permanent limp or prevent normal walking.
One prospective study specifically evaluated walking after first MTP arthrodesis using computerized gait analysis. At an average follow-up of more than eight years, researchers found no significant difference in the walking cycle between the operated and non-operated sides in patients who had unilateral MTP fusion. Importantly, patients also reported less pain and an increased ability to walk longer distances. [1]
A separate prospective gait-analysis study found that first MTP fusion actually produced objective improvements in several aspects of gait, including propulsive power, weight-bearing function, and stability. [2]
These findings help explain why a fused big toe does not necessarily mean an abnormal walking pattern.
Why Can You Walk Without a Moving Big Toe Joint?
A common concern is:
"If my big toe won't bend anymore, how can I push off when I walk?"
Walking is a coordinated movement involving the ankle, foot, and toes. Although the 1st MTP joint no longer moves after fusion, other joints and structures continue to contribute to forward progression.
More importantly, a severely arthritic MTP joint may already be limiting your ability to push off because movement is painful.
By eliminating that painful motion and creating a stable first ray, fusion can allow the foot to function more comfortably.
Research has demonstrated this improvement in function. In a gait-analysis study of patients with hallux rigidus, first MTP fusion was associated with increased ankle push-off power, improved weight-bearing function, and improved gait stability after surgery. [2]
Can I Still Be Active After a 1st MTP Fusion?
Yes.
One of the major benefits of a successful 1st MTP fusion is that it can allow patients to return to a wide variety of physical activities.
Depending on your individual recovery and the activities you enjoy, you may be able to return to:
Walking
Hiking
Bicycling
Swimming
Golf
Weightlifting
Low-impact exercise
Running
Other recreational sports
Research supports these encouraging outcomes.
A study specifically examining young, active patients after first MTP fusion found that patients participated in 22 different sports and physical activities following surgery. The most common activities included walking, biking, weightlifting, swimming, running, and golf.
At follow-up, 96% of patients were satisfied with their return to sports and physical activities. Patients returned to 44.6% of their preoperative activities in less than six months and eventually reached their maximum level of participation in 88.6% of activities. [3]
Importantly, the study also found that some activities were more difficult for some patients after surgery. That is an important part of setting realistic expectations: a first MTP fusion generally does not prevent an active lifestyle, but certain activities may feel different after surgery. [3]
What Does the Research Say About Returning to Sports?
A 2023 systematic review looked specifically at the available research on returning to sports after first MTP arthrodesis. The review included 10 studies involving a total of 450 patients.
For activities including running, yoga, golf, hiking, tennis, elliptical training, and biking, the majority of reported patients said their difficulty performing the activity remained the same after surgery. Depending on the activity, approximately 67% to 88% of patients reported no increase in difficulty. A smaller percentage reported that activities became easier, while only a minority reported increased difficulty. [4]
This is encouraging evidence for active patients considering fusion.
The take-home message is simple:
A fused big toe does not automatically mean giving up the activities you enjoy.
Can I Walk Long Distances After a 1st MTP Fusion?
Walking is one of the activities that tends to improve significantly after successful first MTP fusion.
A study evaluating the functional outcomes of first MTP arthrodesis found a significant reduction in difficulty performing daily activities. The greatest improvements were seen in the ability to walk distances and participate in low-impact sports. Most patients reported little to no functional limitation and were satisfied with their results. [5]
This is particularly important for patients whose arthritis has made walking painful.
If your big toe hurts every time you push off, eliminating the painful movement can sometimes make walking feel substantially better—even though the joint itself is no longer moving.
Can I Hike After a 1st MTP Fusion?
For many patients, hiking is a realistic goal after the fusion has fully healed.
Hiking was specifically included among the sporting activities evaluated in the systematic review of return to sport following first MTP arthrodesis. The majority of reported patients found that the difficulty of participating in their sporting activity remained the same after surgery, with some reporting that activities actually became easier. [4]
Your ability to hike will depend on the terrain, distance, footwear, your overall conditioning, and your individual recovery.
But a first MTP fusion does not inherently mean that hiking is off the table.
Can I Run After a 1st MTP Fusion?
Running is possible for some patients after first MTP fusion.
In the study of younger, active patients, running was one of the most common activities reported following surgery. Patients were able to participate in a broad range of recreational activities, and 96% were satisfied with their return to physical activities. [3]
However, running places significantly more stress on the foot than walking. For that reason, returning to running should be individualized and should only occur after your fusion has healed and your surgeon has cleared you for higher-impact activity.
The goal is not to promise that every patient will return to every sport at exactly the same level. Rather, the evidence shows that many active patients are able to return to sports following first MTP fusion.
Does a 1st MTP Fusion Cause a Limp?
A permanent limp is a common fear among patients considering big toe fusion.
Fortunately, the available research is reassuring.
In a study evaluating real-world function following first MTP arthrodesis, 97% of patients reported that they could walk without restrictions or pain, while 98% reported that they could walk at a normal pace. Additionally, 95% said that losing motion in their big toe did not affect their daily function. [6]
Another gait study found no significant difference in the walking cycle between the operated and non-operated sides in patients who underwent unilateral MTP fusion. [1]
These studies support the idea that a well-healed first MTP fusion can provide a functional, stable foot rather than a permanently abnormal gait.
What About Shoes After a 1st MTP Fusion?
Most patients can wear a variety of everyday shoes after recovery.
Because the big toe is positioned in a functional alignment during surgery, patients can generally return to athletic shoes, boots, sandals, and many types of everyday footwear.
However, very high-heeled shoes may be more difficult or uncomfortable because the big toe no longer bends at the MTP joint.
Your footwear choices may also depend on your foot shape, swelling, surgical alignment, and the type of shoes you prefer.
Does a 1st MTP Fusion Limit Your Lifestyle?
For most patients, a first MTP fusion does not represent the lifestyle limitation they initially fear.
The purpose of the surgery is to eliminate painful movement at a damaged joint while maintaining a functional foot.
Multiple studies have demonstrated improvements in walking, daily activities, and recreational activity following first MTP arthrodesis.
One study of 53 patients with successful first MTP fusions found significant improvements in daily function, with the greatest improvements involving walking distances and low-impact sports. Most patients had little to no functional limitation following surgery. [5]
Another study found that patients were able to participate in a wide variety of sports and physical activities following fusion, with 96% satisfied with their return to activity. [3]
And in a study evaluating patients' real-world function after first MTP arthrodesis, 97% could walk without restrictions or pain and 98% could walk at a normal pace. [6]
The Bottom Line
A fused big toe does not necessarily mean a stiff, painful, or abnormal foot.
For many patients, the opposite is true.
The goal of 1st MTP fusion is to eliminate painful motion at a severely damaged joint and create a stable, functional foot. Once the fusion has healed, research shows that many patients can:
Walk normally or at a normal pace
Walk longer distances
Participate in daily activities without significant limitation
Hike
Bike
Swim
Play golf
Exercise
Participate in low-impact sports
Return to running and other recreational activities in appropriate patients
The scientific literature does not suggest that every patient will return to every activity at exactly the same level. Some activities may feel different, and some patients may have difficulty with high-impact sports or particular types of footwear.
But the overall evidence is encouraging: first MTP fusion can provide a stable, pain-free, highly functional foot while allowing many patients to maintain an active lifestyle.
If severe arthritis or hallux rigidus is keeping you from walking, exercising, or enjoying the activities you love, a first MTP fusion may be an option worth discussing with a foot and ankle specialist.
References
1. Picouleau A, Orsoni N, Hardy J, et al. Analysis of the effects of arthrodesis of the hallux metatarsophalangeal joint on gait cycle: results of a GAITRite® treadmill test. International Orthopaedics. 2020;44(10):2167-2176. PMID: 32683459.
View study on PubMed
2. Brodsky JW, Pollo FE, Crenshaw SJ, et al. Prospective gait analysis in patients with first metatarsophalangeal joint arthrodesis for hallux rigidus. Foot & Ankle International. PMID: 17296132.
View study on PubMed
3. Da Cunha RJ, MacMahon A, Jones MT, et al. Return to Sports and Physical Activities After First Metatarsophalangeal Joint Arthrodesis in Young Patients. Foot & Ankle International. 2019;40(7):745-752. PMID: 30990076.
View study on PubMed
4. Return to Sport After First Metatarsophalangeal Arthrodesis: A Systematic Review. PMID: 37750390.
View systematic review on PubMed
5. Functional Outcomes Following First Metatarsophalangeal Arthrodesis. PMID: 27060128.
View study on PubMed
6. Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? Journal of Foot & Ankle Surgery.2023;62(2):254-260. PMID: 35999115.
View study on PubMed
