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1st MTP Interpositional Arthroplasty w/ Dermal Graft

John G. Kennedy, MD, FRCS, Lower Limb, Foot and Ankle, Cartilage Restoration, Orthopedic Surgeon, West Palm Beach, New York / Foot & Ankle / Post-op Protocols / Patient Surgery Binder / 1st MTP Interpositional Arthroplasty w/ Dermal Graft

This protocol provides you with general guidelines for initial stage and progression of rehabilitation. Please note this protocol is a guideline. Specific changes will be made by the physician as appropriate for the individual patient.

Phase I: Weeks 0-2

General

  • Either postop shoe or splint
  • Heel weightbearing only
  • Elevation is the key to control swelling

Phase II: Weeks 2-4

General

  • Return to office for suture, splint removal and X-Ray
  • Go into post op shoe (if not in one already) and start 10% weightbearing through the forefoot increasing daily.

Goals

  • Control swelling (elevate as needed)

Exercises

  • Range of motion (ROM) of the 1st

Phase III: Weeks 4-6

General

  • Return to office for X-Ray

Goals

  • should be fully weight bearing
  • transition into sneaker

Exercises

  • Continue with range of motion exercises of the 1st MTP

Phase III: Weeks 6 weeks +

General

  • Start physical therapy for distraction ROM and modalities.

Goals

  • Normal gait pattern
  • Full strength and endurance
  • Full range of motion

General

  • Return to regular activities

Exercises

  • Continue strengthening, proprioception training, and progress to running.

Return to full unrestricted activity or sports when cleared by a physician

General Post-Operative Care

Dressings

  • Maintain primary dressings until the two week mark post-surgery, unless otherwise instructed by your provider.
  • Have a water proof cover available to protect your dressing or splint while in the shower.

Infection

  • Observe for any signs of infection including redness, warmth, dehiscence or opening of the incision, or drainage at the incision site. Notify your provider right away if you experience any of these symptoms.

Pain Management

  • Talk to your doctor about your pain medication regimen before and after surgery. Usually, prescription pain medications can be taken every 4-6 hours. OTC Tylenol can be taken for breakthrough pain, the maximum dose for Tylenol is 3,000 mg per day for adults.
  • OTC stool softeners may be taken concurrently with your prescription pain medication to reduce the risk for opioid induced constipation.
  • Pain medications commonly have a side effect of drowsiness. Refrain from any activities that require strict attention after taking these medications (ie operating heavy machinery, driving, etc).

Swelling

  • Icing and elevating the affected extremity above the level of the heart can help alleviate swelling. Icing can be done 2-3 times a day or as needed.
  • Avoid applying the ice directly on your skin for a prolonged period of time as this may cause blisters.

Range of Motion (ROM)

  • Once your splint is removed, Range of motion exercises are encouraged to reduce stiffness.
  • In the ankle, ankle pumps (dorsiflexion and plantar flexion exercises) for 5-10 minutes about three times is encouraged.
  • In the toe, flexion exercises of the joint are encouraged.

Deep Vein Thrombosis (DVT)

  • Talk to your provider about Prophylaxis treatment for Deep vein thrombosis (DVT) needed for your surgery.
  • Antiplatelet and anticoagulant medications can increase your risk for bleeding and bruising.
  • If you experience any severe calf pain, leg swelling, along with chest pain and shortness of breath, call 911 or go to the nearest hospital as this can be a sign of a life threatening condition.