The first metatarsophalangeal (MTP) joint, is the big toe joint. Bones spurs can develop on the top surface of the big toe joint due to arthritis of the big toe, also known as hallux rigidus. The spurs block the toe's motion, which causes pain. A first MTP cheilectomy is a surgical procedure that removes these bone spurs. The goal of the procedure is to relieve pain and improve range of motion in the big toe.
Pain with limited motion of the big toe or pain with direct pressure from shoes could be signs that surgery is needed. However, you should first try non-surgical treatments, such as wearing a stiff shoe or a rigid insert, and/or taking anti-inflammatory medications or an injection. Surgery may be recommended when these efforts fail to relieve your pain.
Your foot and ankle orthopaedic surgeon will remove the spurs on the top of the metatarsal and phalanx bones in your big toe and clean out the joint. They will also remove any free-floating debris in the joint. This may allow the joint to have more range of motion and should decrease pain with walking and standing. No metal, implants, or other hardware are put in the foot.
Specific Technique
Your surgeon will make an incision over the top of the first MTP joint, taking care to avoid the tendon that extends the big toe. Any bone spurs are removed. If there is inflamed joint tissue or debris, this is removed as well. The cartilage on the joint surfaces is inspected. Approximately 30% of the top portions of the head of the metatarsal bone and corresponding bone spurs are removed.
After the surgery, your foot is put in a soft dressing. Your foot and ankle orthopaedic surgeon will encourage you to keep your foot elevated for a few days to minimize swelling. You normally can bear full weight on the foot immediately after surgery in a post-op shoe or walking boot. The sutures will be removed once the incision has healed. Your surgeon may have you perform range-of-motion exercises on the toe. As the swelling goes down, you will be able to transition back into a regular shoe, usually 2-4 weeks after the procedure.
X-ray images before (left) and after (right) MTP cheilectomy surgery. The arrows show where the bone spur on the top of the big toe joint was removed.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
With a cheilectomy, there is a risk of numbness along the big toe, a painful scar, or an incision that does not heal properly. Arthritis is a progressive problem, and you may continue to have pain after the surgery. While most patients do well with a cheilectomy for more than 10 years, some may need additional surgery, such as a fusion, which removes the cartilage of the joint and joins the bones of the big toe together. This can occur in 20-30% of patients with big toe arthritis.
Original article by Katherine Ma, MD
Contributors/Reviewers: W. Bret Smith, DO; Patrick Maloney, MD; Sudheer Reddy, MD
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