Cheilectomy of 1st MTP
Cheilectomy is a procedure to remove the bone spurs that occur about the great toe 1st MTP joint. This procedure is done to relieve pain at that joint, and to improve motion. It does not do anything to the cartilage surfaces at the joint. Cheilectomy of the 1st MTP is done as an outpatient. It can be done with a general anesthetic or an ankle block.
During the surgery I will remove the spurs, and free the tissue to increase the motion at the joint. An incision is made over the top of the great toe that extends for about 3 inches.
Day of Surgery
At the end of the surgical procedure the wound is covered and the foot is wrapped with a dressing that is securely taped into place. That dressing gives support to the foot, acting like a cast to hold it securely. That dressing should be left in place until I change it at the first post-operative office visit.
You will be given a post-operative shoe at the surgery center, and you may put all of your weight on the foot if you have that shoe on. You must not walk on the operated foot unless you are wearing the post-operative shoe. Some people sleep with the shoe on for the first few days after surgery because it gives them a sense of more security, but you do not have to keep it on unless you are walking.
You should try to keep your foot elevated as much as possible to minimize swelling.
If the dressing gets wet or there is a problem with it, please call the office so I can remove it myself.
Look here for things to watch for after outpatient surgery.
Dealing with post-operative pain will be your major concern for the first few days.
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the dressings, wash your foot, and take out the skin stitches.
After the stitches have been removed I will have you manually manipulate your great toe. It is then very important to continue with exercises for the great toe so that the amount of motion that ultimately results will be maximized. You will continue to use your postoperative shoe for an additional two weeks, and then may start wearing whatever shoe feels comfortable.
I will generally see you a second time two weeks after the first postoperative visit. At that time we will determine if you should have formal physical therapy to help with improving motion at the great toe.
The final visit will usually be four to six weeks later. If there are any problems or questions then we will deal with them as they present. Most patients have swelling about the surgical area that lasts for about 4 months after surgery. It is usually between three and four months before all activities can be resumed.
The goal of the surgery is to leave you with a painless foot that will allow normal activities and unrestricted shoewear. You should be able to regain full strength and power in the foot. Most patients have some restriction of motion by the great toe, but hopefully it will not cause any limitations. The toe should maintain a satisfactory alignment. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.
In some patients the toe remains quite stiff, and may still be painful. If that is the result, it may be necessary to have further surgery with an arthrodesis of the 1st MTP.
Complications can occur with any surgery.
Specific risks of this operation include persistent stiffness, joint pain, and the need to have further surgery to fuse the joint, 1st MTP Arthrodesis.