Surgical Fusion vs Watchful Waiting in Hallux Rigidus

Published on Aug 12, 2026

3 min read

Indian doctor discussing Surgical Fusion vs Watchful Waiting in Hallux Rigidus

"A randomized trial proves first MTPJ arthrodesis significantly reduces walking pain in severe hallux rigidus compared to watchful waiting at 12 months."

Symptomatic hallux rigidus causes persistent pain and gait limitation. Consequently, orthopedic surgeons frequently recommend first MTPJ arthrodesis for long-term relief. A landmark randomized trial now offers clear evidence comparing surgical fusion to non-intervention.

Key Study Findings on First MTPJ Arthrodesis

Researchers conducted a parallel-group trial involving ninety adult patients. Specifically, participants had radiographically confirmed stage I to III hallux rigidus. Additionally, all patients reported walking pain scoring four or higher on a numerical scale.

Furthermore, the trial divided participants equally between surgical fusion and watchful waiting. Surgeons performed first MTPJ arthrodesis using lag screws and dorsal plates. Meanwhile, control subjects received conservative monitoring without surgical intervention.

Clinical Outcomes and Pain Reduction

At 12 months, the surgical group demonstrated dramatic clinical improvements. In fact, their mean walking pain score dropped to 1.3. In contrast, the watchful waiting group maintained a mean score of 5.7.

Therefore, the adjusted mean difference reached minus 5.0 points. This result far exceeded the minimal clinically important threshold of 1.7 points. Consequently, joint fusion provides predictable, meaningful relief for symptomatic big toe osteoarthritis.

Frequently Asked Questions

Q1: What is first MTPJ arthrodesis?

First MTPJ arthrodesis is a surgical procedure that permanently fuses the metatarsophalangeal joint at the base of the big toe to eliminate pain caused by severe osteoarthritis.

Q2: Is surgery superior to watchful waiting for hallux rigidus?

Yes, recent clinical evidence demonstrates that surgical fusion provides significantly better pain relief and functional restoration compared to watchful waiting at 12 months.

References

Miettinen M et al. Surgery Versus Watchful Waiting for First Metatarsophalangeal Joint Osteoarthritis : A Randomized Controlled Trial. Ann Intern Med. 2026 Aug 11. doi: 10.7326/ANNALS-26-00710. PMID: 42574728.
Acker A et al. Arthrodesis for Hallux Rigidus. Foot Ankle Clin N Am. 2024;29(2):215-228.