Cheilectomy is an operation to remove bone spurs from the top of the big toe joint to improve range of motion and reduce pain. It is a joint-preserving alternative to fusion for mild to moderate hallux rigidus.
An incision is made over the top of the big toe joint. The dorsal osteophytes (bone spurs) are removed from the metatarsal head and proximal phalanx, along with any loose bodies and inflamed synovium. Approximately 25–30% of the metatarsal head surface is removed. The operation takes 30–45 minutes and is usually a day case.
Cheilectomy is recommended for mild to moderate hallux rigidus (grades I–II) where the main problem is dorsal impingement from bone spurs. It preserves joint motion unlike fusion.
Stiff-soled shoes, rocker-bottom shoes, corticosteroid injection, activity modification, and anti-inflammatory medication.
Weight-bearing X-rays to grade the arthritis. Day-case procedure.
Improved dorsiflexion range and reduced pain in approximately 80–90% of patients with appropriate grade disease. Joint motion is preserved.
Bone spurs may regrow over time.
Forefoot swelling for several weeks.
Some limitation may persist.
The underlying arthritis may progress, eventually requiring fusion.
Alteration of toe alignment.
Wound infection.
Dorsal digital nerve, causing numbness.
Local ankle block, regional, or general anaesthesia.
Post-operative shoe for two to three weeks. Normal footwear at three to four weeks. Full recovery six to eight weeks. Toe mobilisation exercises immediately.
Review at two weeks and six weeks.
If cheilectomy does not provide lasting relief, first MTP fusion remains available as a definitive solution. Cheilectomy does not compromise future fusion.
Most patients enjoy good results for five to ten years. Some eventually progress to needing fusion as the arthritis advances.