Cheilectomy

Hallux rigidus is a degenerative condition affecting the joint at the base of the big toe (the first metatarsophalangeal joint). It is characterized by progressive cartilage wear and the formation of small bony growths (bone spurs), particularly on the top (dorsal aspect) of the joint. As the condition progresses, patients may experience pain, stiffness, and limited upward movement of the big toe, especially during walking or push-off, which can interfere with daily activities and footwear tolerance.¹

Cheilectomy is a joint-preserving surgical procedure designed to relieve pain and improve motion by removing bone spurs and a portion of the dorsal surface of the big toe joint (metatarsal head) that cause impingement, while preserving joint stability. It is most commonly recommended for patients with mild-to-moderate hallux rigidus whose symptoms persist despite conservative treatments such as activity modification, orthotics, pain medication, or injections.¹

The procedure can be performed using an open or minimally invasive technique; these approaches mostly differ in how the joint is accessed:
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● Open cheilectomy: access to the joint through one standard incision on the top of the foot.
● Minimally invasive cheilectomy: access to the joint through smaller incisions in aim to help reduce soft-tissue disruption.
        ●   A small camera (arthroscopy) may be used in some patients to improve visualization, better remove inflamed tissue, and clear bone debris.²
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Though minimally invasive techniques use smaller incisions and specialized instruments, outcomes have been shown to be similar to the traditional open approach.² In all cases, cheilectomy preserves the joint so as not to limit future surgical options. If arthritis progresses over time, additional procedures such as joint fusion may still be performed if needed.¹ 

Cheilectomy is generally associated with good outcomes and a low complication rate. Across both techniques, the overall complication rate is approximately 11%, the most common ones consisting of:
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● Residual pain (≈7.5%): due to incomplete bone spur removal, progression of arthritis, or advanced joint degeneration.
● Revision surgery (≈7.4%): need for repeat cheilectomy or joint fusion due to persistent pain or disease progression.
● Nerve injury (≈2–4%): irritation or injury to small sensory nerves causing numbness or tingling, usually temporary and more common with minimally invasive techniques.
● Joint stiffness or limited range of motion: sometimes caused by postoperative scarring or ongoing arthritic changes.
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Other possible but rare complications include infection (≈0.6%), delayed wound healing (≈0.7%), and injury to a tendon (extensor hallucis longus) (≈0.4%), and are typically related to surgical or patient-specific factors.³ Any other general surgical and anesthesia-related risks will be discussed with you prior to surgery if applicable.

Before surgery, your surgeon will examine your foot and assess the range of motion of the big toe joint. X-rays are typically obtained to evaluate joint space narrowing, bone spurs, and overall alignment. Cheilectomy is usually performed under regional anesthesia with potential sedation, or under general anesthesia, depending on patient and surgical factors. After surgery, your foot will be carefully dressed to protect the incision, and pain is usually managed with acetaminophen and anti-inflammatory medications.

Most patients go home the same day as surgery. Weight-bearing is often allowed immediately using a rigid postoperative shoe. Sutures and dressings are typically removed after about two weeks, and early motion of the big toe is encouraged to reduce stiffness. Most patients can return to regular footwear within 4 to 6 weeks and resume normal daily activities shortly thereafter, with continued improvement in pain and function over the following months. Follow-up visits with your surgeon ensure appropriate healing and recovery.

Razik A, Sott AH. Cheilectomy for Hallux Rigidus. Foot Ankle Clin. 2016;21(3):451-457. doi:10.1016/j.fcl.2016.04.006
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Fletcher AN, Patel V, Cerrato R. Minimally Invasive Cheilectomy for Hallux Rigidus. Foot Ankle Clin. 2024;29(3):471-484. doi:10.1016/j.fcl.2024.01.003
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Arceri A, Di Paola G, Mazzotti A, et al. Reviewing Evidence and Patient Outcomes of Cheilectomy for Hallux Rigidus: A Systematic Review and Meta-Analysis. J Clin Med. 2024;13(23):7299. Published 2024 Nov 30. doi:10.3390/jcm13237299