Using a mirror to walk ‘Heel-to-toe’ can help to improve confidence to put normal pressure on the big toe. Normal walking helps to promote the upward motion, although some patients subconsciously walk temporarily on “the outside border” of the foot to decrease pressure on the big toe. A simple exercise of gently moving the great toe up and down is important to prevent stiffness. Range of motion exercises and occasionally physical therapy are started once the wound has healed. Sutures are removed as soon as the incision heals, usually about 2 weeks after surgery. Most patients will take a few days off from work or school in order to have the freedom to elevate the foot frequently to control swelling. Some patients prefer to use crutches or a cane for a few days after surgery for comfort. Patients are typically able to rapidly remobilize with weight bearing as tolerated in a stiff-soled shoe almost immediately after surgery. Instructions for bandage and wound care are given. Figure 1: Great Toe Cheilectomy (bone spur removal) for treatment of mild Hallux Rigidus (arthritis of great toe) In some patients, pain control can be an issue that is best handled prior to going home. The most common reasons for overnight hospital stays are related to management of other medical conditions such as diabetes, high blood pressure or asthma. Many surgeons will offer an option of local anesthesia for the procedure. The procedure is performed as day surgery in almost all cases. A sterile bandage or wrap is used to protect the area after surgery. The incision is typically about 5-7 cm long, and sutures or surgical clips are used to close the incision. This bone spur and arthritic area is removed in order to allow increased motion and improvement in symptoms. Typically, the top third of the first MTP joint has arthritic changes. The procedure is performed by making an incision centered over the top of the 1st MTP joint. The tendon that extends the big toe is protected. The cartilage of the joint is inspected. ProcedureĪ cheilectomy does not involve metal or other implants, it is a trimming of bone from the area of the bump or spur (Figure 1). more severe or end/late-stage hallux rigidus). Some occupations and recreational activities may require this joint mobility, so it is important to advise your surgeon of all activities to discuss realistic expectations of this procedure. The cheilectomy procedure is not indicated in patients with extensive arthritis involving the entire joint (i.e. In all age groups, the bone spur removal is designed to improve mobility of the joint. While older patients more commonly have arthritis of the big toe, it can be seen in younger adults due to sports trauma or other conditions. This procedure is effective only for patients who have arthritis involving the top part (dorsal aspect) of the great toe joint (first MTP joint). 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. This procedure is indicated in those with painful, limited motion of the big toe that does not respond to non-surgical treatment. Great Toe Cheilectomy (Bone Spur Removal)Ī 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.”