A cheilectomy is a surgical procedure to remove excess bone from the joint of your big toe, also called the dorsal metatarsal head. The surgery is typically recommended for mild-to-moderate damage from osteoarthritis (OA) of the big toe.
Read on to learn more about the procedure, including what you’ll need to do to prepare, and how long recovery takes.
A cheilectomy is performed to provide relief of pain and stiffness caused by hallux rigidus, or OA of the big toe. The formation of a bone spur over the main joint of the big toe can cause a bump that presses against your shoe and causes pain.
The procedure is usually recommended when nonsurgical treatments have failed to provide relief, such as:
- shoe modifications and insoles
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- injectable OA treatments, such as corticosteroids
During the procedure, the bone spur and a portion of the bone — typically 30 to 40 percent — is removed. This creates more space for your toe, which can reduce pain and stiffness while restoring range of motion in your big toe.
You’ll be given specific instructions on how to prepare for your cheilectomy by your surgeon or primary care provider.
Generally, preadmission testing is required to ensure the procedure is safe for you. If required, preadmission testing is usually completed 10 to 14 days before your surgery date. This may include:
These tests will help identify any underlying health issues that could make the procedure risky for you.
If you currently smoke or use nicotine, you’ll be asked to stop before the procedure. There’s that nicotine interferes with wound and bone healing following surgery. Smoking also increases your risk of blood clots and infection, so it’s recommended that you quit smoking at least four weeks before surgery.
Unless otherwise specified, you’ll also need to avoid certain medications, including NSAIDs and aspirin for at least seven days before surgery. Make sure to tell your provider about any other OTC or prescription medications you take, including vitamins and herbal remedies.
You’ll also likely need to stop eating food after midnight before surgery. However, you can usually drink clear fluids up until three hours before the procedure.
Finally, make plans for someone to drive you home after the procedure.
A cheilectomy is usually done while you’re under anesthesia, meaning you’re asleep for the procedure. But you may only need local anesthesia, which numbs the toe area. Either way, you won’t feel anything during surgery.
Next, a surgeon will make a single keyhole incision on top of your big toe. They’ll remove excess bone and buildup of bone on the joint, along with any other debris, such as loose bone fragments or damaged cartilage.
Once they’ve removed everything, they’ll close the incision using dissolving stitches. They’ll then bandage your toe and foot.
You’ll be monitored in a recovery area for two or three hours after surgery before being discharged to whoever is taking you home.
You will be given crutches and a special protective shoe to help you walk. These will allow you to stand up and walk after surgery. Just make sure you don’t put too much weight on the front of your foot. You’ll be shown how to walk with a flat foot, placing more weight on your heel.
In the first few days after surgery, you’ll likely have some throbbing pain. You’ll be prescribed pain medication to make you comfortable. Swelling is also common, but you can usually manage it by keeping your foot elevated whenever possible during the first week or so after surgery.
Applying an ice pack or bag of frozen vegetables will also help with pain and swelling. Ice the area for 15 minutes at a time throughout the day.
Your provider will give you bathing instructions to ensure you don’t interfere with the stitches or healing process. But once the incision heals, you’ll be able to soak your foot in cold water to reduce swelling.
In most case, you’ll be sent home with some gentle stretches and exercises to do as you recover. Make sure you fully understand how to do them, as they can make a big difference in the recovery process.
Your bandages will be removed roughly two weeks after surgery. By then, you should be able to start wearing regular, supportive shoes and walking as you usually would. You should also be able to start driving again if the procedure was done on your right foot.
Keep in mind that the area may be a little sensitive for several more weeks, so make sure to slowly ease back into high-impact activities.
Complications from a cheilectomy are very but possible, as with any surgical procedure.
Possible complications include:
- blood clots
See your doctor if you experience signs of infection, such as:
- a fever
- increased pain
- discharge at the incision site
Seek emergency treatment if you notice signs of a blood clot. While very rare, they can be serious if left untreated.
Signs of a blood clot in your leg include:
- swelling in your calf
- firmness in your calf or thigh
- worsening pain in your calf or thigh
In addition, there’s always a chance that the procedure won’t fix the underlying issue. But based on existing studies, the procedure has a failure rate of just .
A cheilectomy can be an effective treatment for mild-to-moderate damage caused by excess bone and arthritis in the big toe. But it’s usually only done after unsuccessfully trying nonsurgical treatment.