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Big Toe Joint Debridement (Cheilectomy)

A cheilectomy is a surgical procedure to remove bone spurs and excess bone growth around the big toe joint (1st MTP joint). It is primarily performed for hallux rigidus (big toe arthritis) in its early to moderate stages when the joint still has some movement.

 

Indications for Surgery:

  • Painful bone spurs that restrict movement and cause discomfort in shoes.

  • Mild to moderate arthritis with preserved joint space.

  • Difficulty bending the big toe, limiting walking, running, or sports.

  • Failure of non-surgical treatments, such as footwear changes and pain relief.

 

Cheilectomy is an effective joint-preserving procedure that can provide long-term symptom relief while maintaining mobility.

What Does the Surgery Involve?

Cheilectomy is performed under regional or general anesthesia.

 

The steps include:

  1. Incision Over the Big Toe Joint – A small cut is made over the top of the 1st MTP joint.

  2. Removal of Bone Spurs and Excess Bone – Overgrown bone at the top of the joint is shaved off to improve movement.

  3. Cleaning of the Joint – Loose cartilage or debris is removed.

  4. Closure and Bandaging – The incision is stitched, and a dressing is applied.

 

Unlike fusion surgery, cheilectomy preserves motion in the joint, making it a preferred option for early-stage arthritis.

Alternative Treatments

Before considering surgery, non-surgical options may help manage symptoms:

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  • Footwear Modifications – Stiff-soled or rocker-bottom shoes can reduce joint strain.

  • Orthotics (Insoles) – Custom insoles provide support and offload pressure.

  • Pain Management – NSAIDs, steroid injections (temporary relief).

  • Big Toe Joint Fusion – A more definitive treatment for severe arthritis where motion is painful.

  • Big Toe Joint Replacement – An option for selected patients, but it carries a higher risk of long-term failure.

 

Cheilectomy is recommended when non-surgical treatments fail, and the goal is to preserve joint motion.

Risks and Complications

Cheilectomy has a high success rate, but some risks exist:

 

General Surgical Risks:

  • Infection (<1% risk) – Treated with antibiotics if needed.

  • Blood Clots (DVT/PE) – Uncommon but possible with prolonged immobility.

  • Nerve Injury – Temporary or permanent numbness around the incision site.

 

Procedure-Specific Risks:

  • Persistent Pain or Stiffness – In some cases, arthritis may continue to progress.

  • Limited Improvement in Motion – Joint movement may not return fully, especially in advanced arthritis.

  • Bony Regrowth (Recurrence of Spurs) – Over time, new bone spurs may form, requiring further surgery.

  • Progression to Severe Arthritis – If arthritis worsens, a fusion or joint replacement may be needed later.

  • Scar Sensitivity – Some patients experience prolonged tenderness at the surgical site.

  • Fracture – Rare, but excessive bone removal can weaken the joint, increasing fracture risk.

 

Studies show that 80% of patients experience significant symptom relief, and many avoid further surgery for years.

Recovery and Rehabilitation

Time Off Work

  • Desk jobs: 1–2 weeks

  • Manual labor: 4–6 weeks

 

Return to Driving

  • 2–4 weeks, depending on swelling and pain.

 

Return to Activities & Sports

  • Walking unaided: 2–3 weeks

  • Running or high-impact activities: 6–8 weeks

 

Rehabilitation Timeline

  • Weeks 0–2:

    • Walk in a stiff-soled shoe to protect the joint.

    • Elevate the foot to reduce swelling.

  • Weeks 2–6:

    • Gradually return to normal footwear.

    • Gentle range of motion exercises to prevent stiffness.

  • 6+ weeks:

    • Resume full activity as tolerated.

    • Minor swelling may persist for several months.

 

With proper rehabilitation, most patients regain pain-free movement and avoid further surgery for a long time.

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