The aim of this exercise regime, is to assist in the range of movement of your big toe joint and to aid healing.
You will be shown how to perform these exercises by the physiotherapist on the ward, before you are discharged from hospital.
A flexible sandal will be provided for you to wear for approximately two weeks after your surgery and, depending on the outcome of your first post-op clinic appointment, you may then be able to transfer into a training shoe, depending on your wound healing.
You will also be given an outpatient appointment to attend the Therapies department.
The following exercises need to commence six hours after your operation
It is important that you begin with your big toe totally in contact with thefloor and loaded (i.e. with your weight going through it).
You can carry out this exercise sitting in a chair, or on the side of the bed, during the first few days following your operation.
For the first week or two, you will have a bandage on to support the toe. This should be light enough to allow you to carry out the exercises.
If you or your physiotherapist feels that it is restricting your movements then please contact your surgeon to arrange a change or adjustment of the bandage.
As your pain improves, you can carry out this exercise in a standing position.
Raise your heel off the floor and keep your big toe in contact with the ground and hold this position for 3 seconds. Your aim is to carry out 10 repetitions of this exercise,3 to 4 times a day, as your comfort and pain allows.
These two pictures above show the correct way to carry out heel raises with your great toe in contact with the ground throughout.
Please note: During the first few days after your surgery, it will be uncomfortable and painful to perform this exercise correctly, with the big toe in contact with the ground.
A common mistake is to load the outer toes and outside of the foot instead, to avoid discomfort.
Once your wound has healed, it is recommended that you gradually increase your exercise regime to 40 to 50 tip - toe loading / heel raise exercises 10 times a day to help prevent stiffness and to increase the range of movement of your new big toe joint.
It is important that you take your painkillers as prescribed and remember, in order to be more comfortable in the early stages, you can carry outyour heel raises effectively from a sitting position initially.
The picture above shows the incorrect way to carry out heel raises: note that the great toe is raised off the ground
This exercise is carried out in a sitting position, with the operated foot resting on a towel, which is laid flat on the ground in front of you. You need to try to grip the towel with all of your toes, hold for three seconds and then release. The aim is to carry out 10 repetitions, 3 to 4 times a day, as your comfort and pain allows.
Observe your big toe with your weight going through it, as you walk and the loading forces need to be concentrated through your big toe.
It is important that in between carrying out your exercise regime, you will need to keep your foot highly elevated so your heel is higher than your hip level. This will help to reduce your pain and
reduce post-operative swelling.
For further information please request a Patient Information PIF 1614 First (1st) Metatarso-phalangeal (MTP) Joint Replacement leaflet.
NICE interventional procedure guidance 140 - www.nice.org.uk/ipg140
Christine Atkinson
Orthopaedic Specialist Nurse
Foot and Ankle Service
Therapies and Trauma and Orthopaedic Directorate
Royal Liverpool and Broadgreen
University Hospitals
