First MTP Joint Cheilectomy

This surgery is indicated for big toe arthritis in its early stages, with predominantly pain with dorsiflexion/extension of the great toe. Patients often report pain on going up hills with this pattern of arthritis. It is not suitable for every patient with big toe arthritis and in select patients can work very effectively.

Figure 1: schematic of big toe cheilectomy surgery

The operation is performed via an incision on the inside part of the toe (medial approach) and the bony spurs are removed from the top of the big toe joint. This will increase the range of motion of the big toe in dorsiflexion in most cases.

 

Success rates: up to 90% of patients have a successful outcome with this procedure if selected appropriately.

 

However this operation does not address the underlying cause of arthritis, it is for symptomatic relief only.

 

Post-operative

  • Surgery is a day-stay.

  • A block of the foot is performed to help with post-operative pain.

  • 0-2 weeks: elevation at home to reduce swelling, walk in post-operative flat shoe

  • 2-4 weeks: transitioning into comfortable wide fitting trainers such as HOKA or ASICS shoes

  • 4-6 weeks: return to walking normally

  • 6 weeks onwards: ongoing range of motion and strengthening

Download post operative care guide 

Risks of surgery

  • Swelling, stiffness

  • Infection

  • Wound healing problems or infection

  • Scar sensitivity

  • Ongoing pain

  • Secondary surgery including conversion to MTP fusion later if disease progresses.

 

[link to post-operative protocol pdf]