A cheilectomy is carried out to remove excessive bone which can form on top of the first joint of the big toe in people who have big toe arthritis (hallux rigidus).
What does it involve?
The procedure involves ‘tidying up’ the big toe joint to remove excess bone and increase movement. It is usually very successful. Surgery is normally carried out as a day case procedure using open surgery or arthroscopy under a general anaesthetic along with an injection around the ankle so that it’s numb and pain-free after surgery.
Immediately after surgery :
- Your foot will be bandaged, numb and pain-free
- You will be referred to a physiotherapist who will give you a personalised rehabilitation plan and help you to walk with a padded stiff shoe that will be supplied
- You will be sent home only when you are comfortable, when you will be given a follow-up appointment and painkillers if required
During the first few weeks:
- Elevate your foot (raise it above your heart) as much as possible to reduce swelling
- Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
- Some blood ooze can be expected. However, if you are worried, contact the Fortius Clinic for advice
- Your doctor may suggest that you take anti-inflammatory medication to reduce pain and swelling
- After a week, move your toe up and down for around five minutes, four times a day or as advised by your physiotherapist. The wound dressing can remain on the toe although you can remove the bandage (you will be shown how to do this before you are discharged)
Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:
- Two weeks - your wound will be checked
- Six weeks - follow-up appointment to discuss your progress
- 12 weeks - follow-up appointment and discharge
When can I start to walk ?
Your surgeon will be able to advise you about the type of shoe you should wear and how quickly you will recover. Below is a guide to what may be advised:
- 0-2 weeks - you will be able to fully weight bear in a hospital shoe
- 2-6 weeks - you will be able to fully weight bear in your own wide shoe/hospital shoe
- After 6 weeks - you will be able to fully weight bear in your own shoes
How do I wash and shower?
During the first two weeks it’s important to keep the bandaging/foot totally dry although you will be able to shower with a waterproof cover over the foot. After two weeks you can shower without the cover if the wound is healed, but gently dab it dry.
How can I look after the wound?
Once the bandage is removed, don’t pull at your scabs but let them fall away naturally. If your wound becomes red, swollen or sore you should contact the Fortius Clinic and arrange to see your consultant to check you don’t have an infection.
Physiotherapy and rehabilitation
Your physiotherapist will be able to give you a personalised rehabilitation programme that includes gait re-education (learning how to walk normally again), toe mobilisation exercises, and reducing swelling and muscle tightness.
When can I start to drive again?
The DVLA states it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot during an emergency stop and this will usually take at least three weeks. Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.
When can I return to work?
This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time, you should be able to return to work after two weeks; if it involves manual work, you may need to have up to six weeks off.
What long-term outcome can I expect after surgery?
- Once the wound has healed you should gradually regain your movement, although in some cases it can take up to three months to return to your normal activities
- In most cases, the procedure is extremely successful, with a 90% satisfaction rate, although you may have mild swelling in your foot for up to a year
- You are unlikely to have further problems for many years, although this does depend on how serious your condition was to start with
What are the risks?
Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:
- The chance of infection is around 1% and can usually be treated with antibiotics. Serious problems caused by infection are very rare and can be treated
- Nerve damage
- Small nerves that supply feeling to the skin near the operation site can be damaged, although the risk of this is small (around 5%). If your toe stays numb after surgery, this may be because the nerve is bruised but this will usually recover
- Deep Vein Thrombosis (DVT)
- You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). However, the risk of DVT after this type of procedure is less than 3% and may be reduced if you keep your ankle moving and carry out the recommended exercises
Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery.