What is a Cheilectomy?
A cheilectomy is a surgical procedure that involves removal of excess bone called bone spurs from the joint at the base of the big toe. It is mainly performed to treat hallux rigidus (big toe stiffness and pain) due to arthritis.
Anatomy of the Foot
The foot and ankle are complex joints. The foot is divided into the forefoot, midfoot, and hindfoot. The forefoot has 1large toe called the hallux or big toe and 4 smaller toes called phalanges. The big toe has 2 bones and 2 joints while the phalanges have 3 bones and 3 joints. The midfoot and hindfoot are responsible for balancing body weight, maintaining stability, and performing activities such as walking and running.
Indications for a Cheilectomy
A cheilectomy is mainly indicated to treat hallux rigidus due to big toe arthritis. Arthritis may develop due to wear and tear repetitive injury, or trauma. Bone spurs or bony lumps can develop on the top of the toe joint resulting in pain and limited movement. A cheilectomy is recommended if conservative measures such as shoe modification, medications, or joint injections fail to relieve symptoms.
Preparation for a Cheilectomy
To prepare for a cheilectomy:
- Your doctor will perform some diagnostic and imaging tests.
- Inform your doctor if you are allergic to any medications.
- Avoid medications such as aspirin that interfere with clotting.
- Avoid smoking and consumption of alcohol.
- Your doctor may advise you to fast from midnight prior to the day of surgery.
- Wear loose, comfortable clothes for the procedure.
- Arrange for someone to drive you home.
Procedure for a Cheilectomy
The procedure is performed in a minimally invasive manner using a keyhole incision but can also be performed as an open procedure using a larger incision.
- Your doctor may perform the surgery under general or local anesthesia.
- A small incision will be made over the joint at the base of the big toe. For the arthroscopic method, your doctor inserts an arthroscope - a thin tube with a camera attached to its end to view the inside of the toe joint - and tiny instruments will be used to remove the excess bone.
- Debris and damaged tissues from the joint are cleaned out.
- Your doctor will then close the incision site using sutures and a dressing will be applied.
- The procedure takes about an hour, and you can usually go home the same day.
Post-operative Instructions for a Cheilectomy
After surgery, you will be taken to the recovery room. Postoperative instructions include:
- Avoid weight-bearing on the leg for a few weeks. You will receive a protective shoe and can walk with crutches.
- Elevate your foot above heart level to avoid swelling.
- Take anti-inflammatory medications as prescribed to control swelling and pain.
- Applying ice to the area also helps reduce pain and swelling.
- Always keep the incision clean and dry to avoid infection.
- Perform the exercises recommended for a successful recovery.
- Avoid driving until your doctor determines it is okay.
Risks and Complications of a Cheilectomy
Risks and complications of a cheilectomy include:
- Scar formation
- Deep vein thrombosis
- Damage to nerves