1. What is a hallux cheilectomy?
A cheilectomy involves removal of bone spurs that involve the top part of the big toe joint (1st MTP joint). These bone spurs occur as a result of early arthritis of the joint and can cause pain and limited motion of the big toe. The word “cheilectomy” means “the cutting away of a lip of bone.”
This procedure is indicated in those with painful, limited motion of the big toe that does not respond to nonsurgical treatment. This is done to allow increased motion through the big toe MTP joint, to decrease shoe wear irritation from the prominence (bump), and to eliminate some early arthritis on the upper surface of the joint. The cheilectomy procedure is not indicated in patients with extensive arthritis involving the entire joint (i.e. more severe or end/late-stage hallux rigidus).
A cheilectomy does not involve metal or other implants, as it is a trimming of bone from the area of the bump or spur. The procedure is performed as day surgery. A Local anesthetic will be administered to the foot prior to the procedure using a needle. The patient remains awake for the procedure, but should not experience any pain. You are lying down for the procedure with a drape to prevent you from seeing the procedure.
The procedure is performed by making an incision centered over the top of the 1st MTP joint while protecting the tendon that extends the big toe. The cartilage of the joint is inspected and the bone spur and arthritic area is removed in order to allow increased motion and improvement in symptoms. The incision is typically about 1-2 inches long, and sutures are used to close the incision after. A sterile bandage or wrap is used to protect the area after surgery.
2. What is the recovery time post-hallux cheilectomy?
Patients are typically able to rapidly remobilize with weight bearing as tolerated in a stiff-soled shoe (e.g. a medsurge) immediately after surgery. Most of our patients walk out after the procedure with a special sandal. This post-op sandal will be provided for you at the time of surgery. The cost for the sandal is $45 and is sometimes covered through private insurance. Instructions for bandage and wound care are given. Most patients will take a 2-4 weeks off from work or school in order to have the freedom to elevate the foot frequently to control swelling. Sutures are removed as soon as the incision heals, usually about 2 weeks after surgery. Range of motion exercises and occasionally physical therapy are started once the wound has healed. A simple exercise of gently moving the great toe up and down is important to prevent stiffness.
Most patients are able to resume their usual lifestyle within 4-6 weeks, although certain high-intensity activities will not be possible right away. Residual pain and swelling can be expected to limit some activities or even work for about three months post-operatively. Each person’s recovery will depend on a number of factors so these timelines are estimates only.
Driving must not be attempted while “impaired” so pain and stiffness should be resolved before returning to safe operation of a motor vehicle. This is usually 1-2 weeks after surgery; possibly longer in some individuals.
Arthritis symptoms usually resolve about one month after surgery. Patients can experience relief for up to 5-10 years following the surgery. Actual mobility of the joint varies from patient to patient, but most report a satisfactory improvement, with gains in mobility continuing up to a year after surgery. We recommend having a lubrication injection (viscosupplement) into the joint as early as 2-3 months after the procedure to assist in both pain and mobility of the joint.
- Progression of arthritis: There is the very real potential for a recurrence or persistence of symptoms after a cheilectomy. This can occur relatively quickly if there was more wear and tear arthritis in the great toe joint than expected. In addition, this surgery does not fully correct the underlying biomechanical forces that caused the arthritic changes in the first place. Therefore, over time the great toe symptoms may have a tendency to recur. If the symptoms recur, it may be necessary to perform a more definitive procedure, such as a hallux fusion or a 1st MTP joint spacer known as Cartiva.
- Local nerve irritation: Irritation to the nerves supplying the big toe can occur as a result of this procedure. In some patients, a partially “numb” area of the big toe results from the surgery. Most nerve problems resolve in about six weeks after adequate healing.
- 3) Wound healing: In most patients, the wound heals with no problems. In patients with medical conditions such as diabetes or inflammatory arthritis, the surgeon may give special postoperative instructions. Smoking may interfere with wound healing, and all advice regarding management of smoking should be carefully followed. In physically active patients, returning “too soon” to regular footwear, or high-intensity activity, can result in unwanted irritation of the wound, even after the wound has healed and the sutures have been removed.
- Infection: A sharp increase in pain, accompanied by redness and tenderness of the skin may indicate infection. If infection occurs it is usually related to the surface of the wound and is easily recognized and treated, usually with oral antibiotics. If a deeper infection is suspected, intravenous antibiotics may be necessary. Please contact our office immediately or seek medical attention if an infection is suspected after the procedure.
- Blood Clots (DVT): In any foot surgery, there is a small risk of developing a blood clot. Since a cheilectomy procedure allows for early mobility, the risk of blood clot is very low. If the lower leg becomes swollen and sore, this should be investigated by a physician. If you have had a blood clot in the past, or have risk factors for blood clots, advise your surgeon.