Do you also have a stiff and painful big toe? Let's learn about Cheilectomy surgery

Have you ever felt unbearable pain in your big toe when you walk, especially when you wear tight shoes? You feel like you can't bend your toe properly, it feels stiff, tight... it feels like it's stuck in a rock. Although you may think this is normal, it could be due to a condition in your big toe joint. Today, we're talking about a surgery called `Cheilectomy`, which is used around the world as a good solution to this problem.

Simply put, what is Cheilectomy?

Okay, let's put this into simple terms. Cheilectomy (pronounced 'kee-lek-to-mee') is a surgical procedure that involves removing the extra bone spurs (called 'bone spurs' ) that grow over the big toe joint. Think of it like a door jamb that prevents your big toe from bending or moving properly. So, by removing the bone spurs, your big toe can bend and move freely again.

What kind of condition is Cheilectomy performed for?

This surgery is mainly done for a condition called `Hallux Rigidus` . This means ``stiff big toe`` . ``Hallux`` means big toe, ``Rigidus`` means stiffness. This is actually a joint inflammation condition that occurs in the main joint of your big toe (medically called ``metatarsophalangeal (MTP) joint``). Strictly speaking, this is a type of ``osteoarthritis`` that also affects joints like the knees and hips.

When you have this condition called `Hallux Rigidus`, painful bone spurs (osteophytes) start to form over the joint. These spurs are what cause the skin to bulge out over the joint. So when you put on your shoes, these spurs get stuck in the top of the shoe, causing unbearable pain. After a while, this pain can make walking very difficult and painful.

Does everyone have to have surgery?

No. A doctor will not immediately recommend surgery as soon as they find out that you have this condition. They will first try to control the pain through other methods without surgery and give you relief. Surgery is a last resort if everything else fails.

These are the treatments that are usually recommended before undergoing surgery:

If your pain does not subside despite these treatments, and you continue to have difficulty performing daily activities, then your doctor will talk to you about a `Cheilectomy` surgery.

Are Cheilectomy and Bunion Surgery Two Different Things?

Yes, there is a clear difference between the two. Many people confuse the two. Both involve removing excess bone, but the main difference lies in the location of the bone spur.

Imagine that the joint of your big toe is a room.

• Cheilectomy is a surgical procedure performed on a lump on the roof of the hallux. This involves removing bone spurs that form on the top of the joint. This condition is called Hallux Rigidus.
• Bunion surgery `(Bunionectomy)` is performed on a bump on the side wall of the room. That is, a bone bump `(bunion)` that forms on the side (inner side) of the joint is removed. We call this condition `Hallux Valgus`.

Simply put, the type of surgery performed depends on whether the bone spur is above or to the side of the joint.

What happens before the surgery?

Before deciding on a date for surgery, your doctor will examine you carefully.

• Physical examination: First, they will carefully examine how far you can bend your big toe up and down, how painful it is when you bend it, and whether there is any swelling.
• X-ray examination: Then an X-ray is taken to see exactly what the condition is like inside the joint, how much cartilage has worn away, and how large the bone spurs have become. This information is used to determine whether surgery is right for you.

Let's talk a little about how the surgery is performed.

During the surgery, a small incision is made on the top of your foot, above the big toe joint. Then, through that incision, they carefully remove the painful bone fragments that are preventing you from bending your toe.

This surgery can be done in two main ways:

1. Open Cheilectomy

In this, a slightly larger incision is made, the joint is opened up to allow for better visibility, and the bone spurs are removed.

2. Minimally Invasive Cheilectomy

In this method, instead of a large incision, a few small holes are made in the skin. Then, a special instrument called a 'burr' is inserted through those holes to crush and remove the bone spurs. The advantage of this method is that there is less scarring and perhaps a slightly faster healing time.

Your doctor will decide which method is best for you.

What happens after the surgery?

This is usually not a major surgery that requires a hospital stay of several days, so you can go home the same evening ( outpatient surgery ).

• A special shoe: After you go home, you will need to wear a special shoe for a few weeks while your foot heals. This will help reduce weight on the surgical site.
• Pain control: To control pain, the doctor may recommend a pain reliever like ibuprofen or acetaminophen.
• Swelling: Your leg may be slightly swollen. It's best to keep your leg elevated as much as possible.

What are the advantages of this surgery?

The biggest advantage of a `cheilectomy` surgery is relief.

Are there no risks or complications?

As with any surgery, there are some risks involved. However, these are rare, and doctors do their best to minimize them.

• Ongoing pain: Some people may still have some pain when bending their finger after surgery.
• Need for further surgery: Rarely, if the condition of `Hallux Rigidus` gets worse, you may need to undergo further surgery to treat it. For example:
• An arthrodesis procedure is a surgical procedure that fuses the bones of a joint together.
• A surgery to reduce pressure on the injured cartilage of the joint (Moberg osteotomy surgery) .
• Other complications: As with any surgery, there is a small chance of infection and scarring. You may also experience pain in the bottom of your foot.

Don't worry about this. Your doctor will discuss these things with you clearly before the surgery.

How long will it take to recover? When can I go back to work?

Healing time varies from person to person.

• Swelling: Your leg may be slightly swollen for a few weeks, or even months, after surgery. This is normal.
• Shoes: Those special shoes should be worn for at least two weeks , until the doctor tells you to.
• Returning to work: Most people can return to work within a month or two . However, if your job requires a lot of walking or standing, or if your pain and swelling are more severe, it may take a little longer to return to work. It's best to discuss this with your doctor.

When you need to see a doctor quickly

When you go home after surgery, be on the lookout for these symptoms. If you have any of these, call your doctor right away.

• If the skin around the incision is very red .
• If that area is excessively swollen .
• If a yellow liquid like pus comes out of the cut.
• If you have unbearable pain despite taking painkillers or if the pain is getting worse day by day.
• If you have a fever .

These could be signs of an infection, so it's important to seek treatment quickly.

Cheilectomy, Hallux Rigidus, Big Toe Pain, Arthritis, Osteoarthritis, Bone Spur, Foot Surgery