A cheilectomy is a foot operation to remove bone spurs of the big toe joint for the treatment of big toe joint arthritis. The arthritic bone spurs generally develop on the top of the big toe joint, which ultimately limits motion and causes pain. Removing bone spurs with cheilectomy is considered a simple and extremely effective operation to alleviate some arthritic big toe joint pain while preserving big toe joint motion.
Arthritis of the Big Toe Joint
Arthritis of the big toe joint, or hallux rigidus, is a degenerative condition of the cartilage resulting in stiffness, pain, and loss of joint motion. Normal joint cartilage is a white, slick, firmish covering that lines the end of a bone to allow two bones to move smoothly against one another. Degenerated cartilage becomes yellow, thin, and eroded, which may expose the underlying bone resulting in pain and grinding motion.
More advanced degeneration may result in benign bone cysts just below the joint surface.1 Bone spurs commonly form around an arthritic joint as a protective measure to limit pain joint motion, and these bone spurs may become quite large and quite bulky.
Arthritis of the big toe is generally classified by a combination of physical symptoms and X-ray findings. There are four stages of arthritis:
The first stage (stage 1) is when there are no X-ray findings, but there's a loss of motion, known as hallux limitus.
The second, third, and fourth stages correlate with worsening arthritic joint degeneration and are classified as mild, moderate, or severe (end-stage); respectively. Mild arthritis is generally uneven loss of joint cartilage. Moderate arthritis includes bone spur formation with minor cystic changes. Severe arthritis is a complete loss of joint cartilage with or without heavy bone spur formation.
The basis for cheilectomy surgery is to remove the bone spurs that surround the joint. Generally, the bone spurs are on the top of the joint. Bone spurs on the sides of the joint may be addressed as well during cheilectomy surgery.
The incision for cheilectomy is generally on the top of the big toe joint, through an incision on the side of the joint may be used in some cases. Bone spurs may be removed manually with an orthopedic chisel or with a power saw. Once the bone spurs are removed there is often immediate increased big toe joint motion.2 Surgeons generally place surgical bone wax on the raw bone surfaces to thwart bone spurs from reforming. In addition to the bone spur removal, the joint is inspected for any internal damage and some areas of cartilage loss and bone cysts may be treated to promote new cartilage ingrowth.
Cheilectomy big toe joint surgery is generally performed as an outpatient procedure under local and without sedation. The surgery generally takes less than one hour. Patients are generally walking immediately after surgery in a surgical shoe. Sutures are removed about two weeks after surgery. Depending on the extent of the arthritis, relief may be experienced after a few days and there is generally a period of adjustment for the joint to adapt to the increased motion.3
Can Cheilectomy Be Performed With Bunion Surgery?
Bunions and arthritis may occur together. A bunion is a malaligned big toe joint which can result in uneven wear and tear on the joint, resulting in big toe arthritis. Bunion surgery generally involves either a bone cut or a bone fusion to realign the displaced bones. The best bunion surgeon advice generally calls for cheilectomy combined with bunion surgery so long as the arthritis is mild to moderate.
Cheilectomy operations are effective because the bone spurs are usually the culprit behind the symptoms in most people. Once the bone spur is relieved, there's typically significant relief. Depending on the extent of the arthritis cheilectomy may alleviate symptoms altogether or lessen it somewhat.
Cheilectomy may not be effective for end-stage arthritis.1 Removing the bone spurs doesn't preclude more advanced procedures to deal with end-stage arthritis. Talk to your surgeon to discuss your options.