Great Toe Cheilectomy (Bone Spur Removal)

Procedure

This procedure involves removing the painful and prominent bone spur on the top of the great toe joint (1st metatarsal head). This is done to allow increased motion through the big toe MTP joint, decrease shoewear irritation from the prominence, and eliminate some early arthritis on the upper surface of the joint. Typically, the top 1/3 of the first MTP joint has arthritic changes (See Figure #1). This bone spur and arthritic area needs to be removed in order to allow increased motion and improvement in symptoms. This procedure is effective only for patients who have arthritis involving the top part (dorsal aspect) of the great toe joint (first MTP joint). It is not indicated in patients with extensive arthritis involving the entire joint (ie, more severe or end/late-stage hallux rigidus).
Patients are typically able to rapidly remobilize with weight bearing as tolerated in a stiff-soled shoe as soon as the incision heals after surgery which often takes about 2 weeks. However, residual pain and swelling can be expected to limit some activities for at least a few more months post-operatively.

Potential Complications

Infection

Wound healing problems

Potential Specific Complications

  • Local nerve irritation: Irritation to the nerves supplying the big toe can occur.
  • Recurrence of Symptoms: There is the very real potential for a recurrence or persistence of symptoms after a great toe cheilectomy. This can occur relatively quickly if there was more wear and tear arthritis in the great toe joint than expected. In addition, this surgery does not fully correct the underlying biomechanical forces that caused the arthritic changes in the first place. Therefore, over time the great toe symptoms may have a tendency to recur. If the symptoms recur it may be necessary to perform a more definitive procedure such as a great toe fusion or a 1st MTP joint replacement.

Edited August 30th 2009