What is a Cheilectomy?
A cheilectomy is an operation to remove extra bone that forms on the top of the big toe joint.
The commonest reason for excess bone over the big toe is osteoarthritis, or ‘hallux rigidus’.
The gradual wearing away of the joint cartilage causes pain and stiffness which is exacerbated by a compensatory growth of bone. By removing this bone, some of the pain of osteoarthritis can be removed as the big toe regains movement.
This image shows spurs forming over the top of bone in the large toe.
After the wound has healed, you should move the toe as soon as possible to help regain movement. You can expect to put weight on your toe the day of the surgery.
This operation can give good temporary relief and is recommended for less severe forms of osteoarthritis. However, as the osteoarthritis worsens, you may need other operations such as a big toe fusion.
Who is this operation for?
Cheliectomy is recommended when sufferers of hallux rigidus (arthritis in the big toe):
- Have tried non-surgical methods, like orthotics and over the counter pain relief
- Have significant pain and stiffness that is impacting on their life and ability to walk
- Are able to tolerate surgery.
While cheilectomy is a fairly minor surgery, some people are not considered able to tolerate the general anaesthetic.
Complications
The most important complication that needs to be considered is failure of the cheilectomy to adequately improve pain and function in the toe. In these cases a follow-up fusion operation (arthrodesis) will need to be performed.
Other complications that sometimes occur in cheliectomy include:
- Numbness and/or tingling in the toe. This is usually temporary and should go away over time.
- The formation of a thick lump of tissue (‘neuroma’) around the toe.
The risks and complications of any surgery include:
- Infection. In any surgery, there is a risk that the incision or underlying tissue may become infected. Your surgeon will prescribe antibiotics to help prevent infection developing, and any signs of redness, swelling and fever will be watched carefully by the doctors caring for you. Rarely, infection can develop in the bone causing osteomyelitis.
- Bleeding. There is usually minimal bleeding during this surgery.
- Blood clots (DVT) and clots in the lungs.
- Reaction to the anaesthetic.
Before the operation
What do I need to do before the operation?
In most cases, you will not need to stay in hospital overnight for a cheilectomy. It is a good idea to get things organised for when you get home. Below is a list of things it might be a good idea to organise:
- Help with household tasks
- Food cupboards stocked up
- Help with shopping
- Help with children, pets and relatives organised for your return home
- Someone to bring you to and from the hospital
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Before your operation, your surgeon will have ordered X-Rays to assess your toe. He or she may also have ordered special tests to assess the blood vessels and soft tissues in your leg.
Tests that may be ordered for you to check you are ready for surgery include:
- blood tests
- Xray of your Chest
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
About the Operation
The operation involves a small incision over the big toe joint. The extra bone is then trimmed away. This also gives your surgeon the opportunity to asses your joint cartilage, and if necessary, trim any excess or damage tissue. The incision is then closed with stitches.
After the Operation
What can I expect after the operation?
When you arrive back on the ward from theatre your leg will be in a bandage and a post op shoe. Your leg will be elevated to reduce swelling. Your foot will be numb due to the local anaesthetic block. This will gradually wear off over 24 hours.
You will be able to take full weight on your foot immediately and will be encourage to start moving the toe as soon as the wound has healed (approximately 12 days). Taking weight on your foot normally will help regain movement.
If you’re feeling unsteady, a physiotherapist can give you crutches and show you how to negotiate stairs. You are still encouraged to move your toe as soon as possible.
What about pain?
Whilst you are in hospital you will be monitored and the medical staff give you painkillers as needed. The Nursing staff ensure that you know what medications to take for pain when you get home.
Keeping your leg elevated helps to control the pain and minimise the risk of your incision becoming infected. You will need to keep your leg elevated 50 minutes out of every hour for the first 2 weeks. This prevents your incision from leaking and becoming infected.
When can I return to work?
Your own circumstances will determine when you feel ready to go back to work. If you have an office-type job and you can elevate your leg then you should be able to return to work sooner. If your job requires a lot of walking or is strenuous then you may need more time off work. You will need to get a sick certificate from the staff at the hospital before you go home, or from your GP.
When can I return to driving?
You must be free of pain and able to perform an emergency stop. This will also depend on which foot was operated on (right or left). If you have had left sided surgery and drive an automatic car you may be able to drive 2-4 weeks following surgery. Your insurance company must be notified regarding the type of operation that you have undergone to ensure that cover is valid.
What should I do if I have a problem?
If you experience severe pain, excessive swelling, inflammation or discharge please report it to your GP. If you cannot contact your GP you should contact A&E.
Recovery and Rehabilitation
What happens after discharge from hospital?
You will go home once you are safely able to cope with walking in this manner. Most patients go home the same day as their surgery. You will be seen at the Dressing Clinic in the Orthopaedic department between 10 days to 2 weeks after your operation. At this appointment, the Nurses will check the incision and remove the dressing and stitches if required.
F.A.Q.s | Frequently Asked Questions
References
Mann, R. A., Disorders of the First Metatarsophalangeal Joint, Journal of the American Academy of Orthopaedic Surgery, Vol. 3, No. 1, Jan/Feb 1995, pp. 34-43.
Yee, G., Lau J., ‘Current Concepts Review: Hallux Rigidus’, Foot & Ankle International, Vol. 29, No. 6, June 2008.