What are the indications for a cheilectomy?
Cheilectomy of the big-toe joint is considered in patients who have early arthritis with end-range joint pain (extreme extension or flexion). The pain is caused by bone spur formation on either side of the joint; cheilectomy involves the removal of these spurs to reduce pain and potentially improve movement. This procedure is not suitable for more advanced stages of arthritis as the increased joint movement may worsen the arthritic pain. Very occasionally a limited cheilectomy may be considered to reduce the bulkiness of the spurs to ease footwear fitting and reduce contact pain; this will have to be judged against potentially worsening the pain within the joint.
What does surgery involve?
This procedure is performed as a day case, normally under general anaesthetic and frequently combined with a local anaesthetic block for pain relief.
A small incision (4-5 cm) is made to expose the joint. The bone spurs on either side of the joint are removed (see X-rays below) using a micro-saw. If there is an area in the joint devoid of cartilage, microfractures (small bone punctures) are performed to encourage scar cartilage to form and fill the defect. In some patients, an additional osteotomy (bone realignment) of the proximal phalanx of the big-toe is undertaken to improve toe extension (Moberg procedure)
The skin is closed using stitches and a bulky dressing is applied. Your foot will be protected in an orthopaedic shoe for 2 to 3 weeks. You will be allowed to walk on the operated foot. It is important to keep the foot elevated as much as possible especially for the first few days.
Pre and post Cheilectomy (bone spur removal from big-toe joint) Xrays
Aftercare and FAQs
You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. You will be followed-up in clinic 12 to 14 days after surgery to check the wound and reduce the foot dressing.
Wound care – The bulky dressing should be kept clean and dry until your clinic appointment.
Walking - You will be able to walk on the day of your surgery unless advised otherwise. You may mobilise freely around the house but long walks or standing for long periods should be avoided. You may need to use a stick or crutches for a few days.
Work - If you have a sedentary job you should be able to return to work within 2 weeks. If your job is physical, you may need to stay off work for at least 4 weeks.
Driving - You will not be able to drive for 2 to 3 weeks following surgery. However, if you drive an Automatic and it was your LEFT foot that was operated on; then you may start short drives 2 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
What are the surgical risks?
Infection - there is a small risk of infection with all surgery.
Swelling - this is quite common. In some people the swelling reduces within a matter of weeks and in others could take a few months.
Deep Vein Thrombosis - also known as Venous Thromboembolism (VTE), this is a rare complication of foot surgery.
Nerve damage – this may leave you with numbness or a sensitive scar
Worsening joint pain
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.