Great Toe Cheilectomy (Bone Spur Removal)

Edited by Daniel Cuttica, DO

Indications

A cheilectomy involves removal of bone spurs that involve the top part of the big toe joint (1st MTP joint).  These bone spurs occur as a result of early arthritis of the joint and can cause pain and limited motion of the big toe.  This procedure is indicated in those with painful, limited motion of the big toe that does not respond to nonsurgical treatment. This is done to allow increased motion through the big toe MTP joint, to decrease shoe wear irritation from the prominence, and to eliminate some early arthritis on the upper surface of the joint. 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 (i.e. more severe or end/late-stage hallux rigidus).

Procedure

A cheilectomy is performed by making an incision centered over the top of the 1st MTP joint.  The tendon that extends the big toe is protected.  The cartilage of the joint is inspected.  Typically, the top third of the first MTP joint has arthritic changes. This bone spur and arthritic area is removed in order to allow increased motion and improvement in symptoms.

Recovery

Patients are typically able to rapidly remobilize with weight bearing, as tolerated in a stiff-soled shoe almost immediately after surgery.  Sutures are removed as soon as the incision heals, usually about 2 weeks after surgery. Range of motion exercises and occasionally physical therapy are started at this time.  However, residual pain and swelling can be expected to limit some activities for at least a few more months post-operatively.

Potential Complications

  • Progression of arthritis: 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.
  • Local nerve irritation: Irritation to the nerves supplying the big toe can occur.
  • Wound healing problems
  • Infection

 

Edited April 14, 2015