Minimally Invasive 1st MTPJ Cheilectomy

Introduction

Metatarsophalangeal joint (MTPJ) is a junction between the metatarsal bones (long bone in the foot) and proximal bones (bone in toes). 1st MTPJ refers to the joint in the big toe of the foot. Cheilectomy is a surgery to remove excessive bone from the 1st MTPJ. The operation is performed through a very small incision which is why it is referred to as minimally invasive. This surgery is intended to treat pain and stiffness and to increase the motion in the joint of the big toe.

Indication

Cheilectomy is designed to treat early arthritis and hallux rigidus. The surgery is performed to treat pain, stiffness and limited range of motion in the joint of the big toe which is caused due to arthritis.

Pre-operative care

Before surgery, the details of your medical history will be collected. Your doctor might recommend you to undergo an X-ray examination. If necessary, you might also be advised to get a CT-scan done.

Surgical procedure

The surgery is carried out as a day-case procedure (no over-night stay in the hospital) and under general or local anaesthesia. A small keyhole incision is made on the side of the foot. The bone spurs that block normal movement of the toe, are excised and the skin is sutured. The procedure will be carried out under live X-ray guidance (fluoroscopy).

Post-operative care

There should be no pain immediately after the operation as a nerve block is routinely performed. Your foot will be dressed with a bandage that you can remove after 2 days. Resting and elevating your foot and taking anti-inflammatory medications will help to reduce discomfort and swelling. A surgical shoe is worn for 2 days initially after surgery. The physiotherapists will guide you with mobilisation exercises to reduce joint stiffness after which you will be able to walk gradually and resume daily activities. You will be advised not to drive a vehicle for 2 days (right foot only).

The most important thing to do after surgery is to keep the joint moving so it doesn’t stiffen up. No damage can be done and how much you move it is only limited by your own level of comfort – the more the better.

Occasionally after 6 weeks or so the joint can stiffen up due to not enough movement initially, but not to worry, a simple injection in the operating theatre can often loosen this up and speed up the recovery process.

Risks and Complications

Risks associated with cheilectomy are:

  • Infection
  • Numbness
  • Deep vein thrombosis
  • Progression of symptoms

Around 80% of the people who have undergone cheilectomy have found it to be effective and safe.

A small minority of patients find that this procedure doesn’t sufficiently help their symptoms. This is because their arthritis has progressed or it was too bad to begin with. Don’t worry as there are other options available, which can be discussed at your follow up appointment.

  • Medical Protection Society
  • General Medical Council
  • British Orthopadeic Association
  • American Orthopaedic Foot Ankle
  • Bofas