Cheilectomy is usually recommended for patients who have mild to moderate Hallux Rigidus, a degenerative condition characterised by changes in the joint such as loss of cartilage, formation of osteophytes at the joint margin (spurs) and changes in the bone (hardening or sclerosis). These changes lead to pain, restriction and rigidity of movement at the big toe (metatarsophalangeal MTP) joint. Cheilectomy involves removing excessive bone spurs and a portion of the big toe bone (osteotomy) allowing more room for the toe to move thus reducing joint stiffness and pain. The underlying disease process may progress and require a conversion to an arthrodesis or arthroplasty in time.

Procedure

Dr du Sart chooses to perform minimally invasive (keyhole) cheilectomy surgery for most of his patients as it allows for less scarring, soft tissue damage, pain and swelling than traditional techniques requiring larger incisions. This usually means a faster recovery for most patients. During the operation the following steps occur:

• A small incision is made on the top of the big toe
• Excessive bone or build up of bone at the joint which block normal movement of the toe are removed 
• In rare cases, additional steps may be required to align the joint. This procedure is done with X-ray guidance and may require screws for stabilisation of the alignment

After Your Operation

Pain Management

Post operation the foot is elevated to reduce swelling and local anaesthetic will provide pain relief and make the foot and toes temporarily numb. During your inpatient stay you will be given pain relief and either medication or prescriptions to go home to keep pain within comfort. Usually patients will initially require regular pain relief consisting of paracetamol and anti-inflammatories if indicated. Stronger medications may be given and helpful in early stages however are phased out as comfort levels increase.

Mobility

After your operation you are able to walk as tolerated with a surgical shoe with optional crutches if needed. It is important to keep the foot elevated as much as possible to manage pain and swelling. You will continue to walk with a surgical shoe for approximately two weeks. Following this it is recommended to walk with wide shoes to manage comfort. You will also be given some stretches and exercise to complete as part of your rehabilitation to reduce muscle tightness and improve mobilisation.

Return to Work and Sport

Return to work will vary on the nature of your work and what was done at surgery. In general, you should plan to have at least two weeks off work to allow your wound adequate time to heal and elevate your leg. You may be able to return to light duties after two weeks, but if you are on your feet at work and physically active, it may take up to 4 to 6 weeks. Dr du Sart will discuss this with you at your post-op check.

Returning to sport such as jogging may take 3 to 6 months however this is dependent on the type and level of activity. Full recovery is expected in approximately 3 to 6 months.

Driving

Times to return to driving will vary. If you have an automatic car and your left ankle was operated on, your return to driving may be faster. However, in general, plan to avoid driving for two weeks after surgery. However if your right ankle has been operated on it is recommended to return to driving after approximately three weeks. If you have concerns, you can discuss this with Dr du Sart.