Big Toe (1st MTPJ) Cheilectomy
A cheilectomy involves removal of bone spurs from the top part of the big toe joint (1st MTP, or metatarsophalangeal, joint). These bone spurs occur as a result of early arthritis of the joint and can cause pain and stiffness in the big toe.
The aim of a cheilectomy is to remove prominent bone spurs caused by early arthritis in the big toe in order to decrease irritation and allow increased range of motion. The procedure is only effective for patients whose arthritis affects the top part (dorsal aspect) of the joint. In more advanced arthritis, with degenerative changes throughout the joint, a cheilectomy is not indicated.
A small incision is made over the top of the 1st MTP joint, and the tendon that extends the big toe (EHL) is protected. Once the joint is entered, the joint surfaces are inspected and the bony spurs are fully exposed. The bone spurs and arthritic area are then cut out on each side of joint. The joint capsule and skin are then closed with stitches, and a local anaesthetic block is given for post-operative pain relief.
This procedure is usually done as a day procedure, and patients can typically mobilise with full weight bearing in a stiff-soled surgical shoe almost immediately after surgery. Some patients may need crutches or a stick for a few days after surgery. After discharge, the dressings and bandages must all stay intact and dry until review 2 weeks after surgery.
A minimum of one week off work or school is usually recommended to allow for rest and elevation to control swelling and pain. At 2 weeks after surgery, the wound is checked and any sutures are removed (most of the time these will be under the skin). Range of motion exercises and occasionally physiotherapy are started once the wound has healed. A simple exercise of gently moving the great toe up and down is important to prevent stiffness. Normal walking helps to promote range of movement in the toe, and once pain has settled down it’s good to practice walking with a heel-to-toe gait pattern (ie rolling all the way through on your foot to propel off your toes).
Most patients can resume normal lifestyle activities within 6 weeks, although some high intensity activities won’t be possible straight away. It is normal to have some residual pain and swelling for about three months post-operatively. Return to intensive sport or high demand physical labour can take up to six months. (Every individual is different so these are estimates only).
The arthritis symptoms will usually be significantly improved by 4 to 6 weeks after surgery, and patients can experience relief for many years afterwards.