Prospective, randomised controlled trial to evaluate the effect of weight bearing on patient outcomes following 1st MTP joint fusion.

Scott Purdie, Joel Morash, Bernard Burgesson, Mark Glazebrook

Aberdeen Royal Infirmary, Aberdeen

Introduction: First Metatarsophalangeal (MTP) joint arthrodesis is a common procedure for the treatment of hallux rigidus and severe hallux valgus with osteoarthritis. Despite its commonality, post-operative weight bearing protocols vary widely. To date, no prospective randomised controlled trials have directly compared outcomes between immediate weight bearing as tolerated (WBAT) and non-weight bearing (NWB) following 1st MTP fusion.

Method: A prospective randomised controlled trial was conducted with 68 patients undergoing isolated 1st MTP fusion, allocated to WBAT or NWB. Standardised surgical technique and fixation methods (screws or plate) were performed by two fellowship-trained foot and ankle surgeons. Primary outcomes were pain measured by the Visual Analogue Scale (VAS) and function measured by the Foot & Ankle Ability Measure, (FAAM–ADL subscale) at 12 months. Secondary outcomes included non-union, complication, and patient satisfaction. Statistical analysis used t-tests and chi-squared or Fisher’s exact tests, with significance at p<0.05.

Results: Sixty-eight patients (33 WBAT, 35 NWB) completed the study. At a minimum 12 months follow-up, both groups demonstrated significant improvements in pain and function. No statistically significant differences were found between WBAT and NWB groups in VAS pain scores (2.97+/-2.215 vs 2.54+/-2.147; p=0.423), FAAM scores (81.31+/-16.028 vs 85.02+/-18.863; p=0.387), or patient satisfaction (8.00+/-2.76 vs 8.34+/-2.52; p=0.594). Complication rates were comparable, with one case of hardware irritation in each group (p=0.739). Plate fixation was more common in the NWB group (p=0.028), this is unlikely to affect outcomes.

Conclusion: Immediate weight bearing following 1st MTP fusion is safe and results in equivalent pain relief, function, satisfaction, and complication rates, compared to traditional NWB protocols. These findings support a shift toward more permissive postoperative strategies, with potential benefits for patient mobility, independence, recovery time, and healthcare resource use.

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