Rheumatoid forefoot surgery

Written by Prof Lyndon Mason, Consultant Foot and Ankle Surgeon. Last reviewed 8 November 2026.

X-ray after big toe fusion with a plate and screws

In short

Rheumatoid forefoot surgery treats pain, deformity and joint damage in the front of the foot caused by rheumatoid arthritis, such as bunions, dislocated or overlapping toes and painful calluses. It is tailored to each foot and may combine fusion of the big toe joint with lesser toe procedures and soft-tissue balancing. You walk on your heel in post-operative footwear or a cast at first, an X-ray at 6 to 12 weeks checks the fusion, and most patients have much less pain and wear normal shoes more comfortably.

Anaesthetic: General or regional anaesthetic
Hospital stay: Usually a day case or short stay
Walking afterwards: Heel or protected weight-bearing in post-operative footwear or a cast
Full recovery: 3 to 6 months and beyond

Why is surgery sometimes needed?

Rheumatoid forefoot surgery is used to treat pain, deformity and joint damage in the front of the foot caused by rheumatoid arthritis. The condition can lead to toe deformities, bunions, dislocated toes and painful calluses that interfere with walking and footwear. Surgery realigns the forefoot, corrects deformity and redistributes pressure to improve comfort and function.

What does the operation involve?

The procedure is tailored to the pattern of deformity and may include:

Big toe correction, such as fusion of the 1st MTP joint for alignment and power
Lesser toe procedures, including shortening osteotomies or MTP resection arthroplasties
Soft-tissue balancing to reduce deforming forces
Callus removal at high-pressure areas
Correction of dislocated toes where required

The surgery is typically performed under general or regional anaesthetic with postoperative support in specialist footwear.

Recovery: what to expect

0 to 2 weeks
- Protected in post-operative footwear or a cast
- Heel or protected weight-bearing as advised
- Elevation helps reduce swelling
- Stitches removed around 10 to 14 days
2 to 6 weeks
- Continued healing with gradual improvements in comfort
- Transition towards more normal footwear depending on swelling and dressing requirements
- Toe alignment maintained with splints or dressings
6 to 12 weeks
- An X-ray will be performed to check on fusion progress
- Return to supportive footwear
- Walking distance increases
- Physiotherapy may assist with balance and gait retraining
3 to 6 months and beyond
- Continued reduction in swelling and callus burden
- Comfort in daily footwear improves significantly
- Most patients regain improved mobility and reduced pain
- Some swelling may persist, especially after prolonged standing or activity

Recovery varies with the exact procedure and with each person. You will get a plan specific to your operation.

Expected outcomes

Before surgery

Painful bunion or toe deformities
Calluses and footwear difficulty
Dislocated or overlapping toes
Reduced walking tolerance

After surgery

Improved alignment and stability
Major reduction in pain and pressure
Better tolerance of normal shoes
Improved confidence and mobility

Most patients maintain good alignment and pain relief long-term. The procedure supports independence and quality of life. Continued rheumatology input optimises overall outcomes.

Rheumatoid forefoot surgery is an effective treatment for deformity and pain affecting the toes and forefoot in rheumatoid arthritis. By correcting alignment, removing pressure points and restoring balance across the foot, the procedure improves footwear comfort, mobility and overall quality of life.

Read the consent form before your operation so you know what you are agreeing to. Bring any questions to your pre-operative appointment.