Big Toe Cheilectomy
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What is a big toe cheilectomy?
A big toe cheilectomy is an operation to remove a bony lump on top of the main joint of the big toe (first metatarsal-phalangeal joint). This is most often caused by arthritis of the big toe (hallux rigidus).
What are the goals of a big toe cheilectomy?
The goals of a big toe cheilectomy are to remove the bony lump that can press on your shoes and be painful. It can increase the joint movement and is successful in reducing symptoms in patients with less severe arthritis.
An operation is only recommended as a last resort, once non-operative measures for hallux rigidus have been exhausted and if your symptoms remain significant. It is not recommended for cosmetic reasons or to avoid problems that are not yet present.
What happens during a big toe cheilectomy?
In most cases the operation is performed under general anaesthetic (whilst you are asleep). Alternatively, you can have a regional anaesthetic, which just numbs the leg.
A surgical cut is made on top of the big toe over the bony lump. The main joint of the big toe is cleaned out, any bony lumps removed and the severity of arthritis is assessed. Once the operation is completed, the wound is closed with stitches, local anaesthetic is given to provide pain relief for the first few hours after surgery and a bulky bandage is applied.
What are the risks of a big toe cheilectomy?
The risks of any operation generally relate to the anaesthetic and the surgical procedure.
You will be able to discuss your anaesthetic options and associated risks with the anaesthetist before your surgery. With a general anaesthetic, the risks will vary depending on your general health.
The main surgical risks of a cheilectomy are listed below, but it is not exhaustive. These will be further explained in the outpatient clinic.
Swelling and stiffness – The foot will swell in response to the surgery and the healing process. It takes more than six months for the swelling to settle. Stiffness in the big toe may persist.
Progression of arthritis – The success rate of the operation depends on the problem and treatment performed. The majority of patients will notice an improvement. However, some patients may develop symptoms related to progression of arthritis in their big toe, which may need further treatment and even another operation.
Nerve injury – With an operation there is always a small risk of injuring or stretching the surrounding nerves, which can lead to numbness. These symptoms mostly resolve in time, but they can persist.
Infection – The wound usually heals within two weeks. In a small number of cases the wounds become infected. The majority are minor infections that can be simply treated with antibiotics. Occasionally, some patients can develop a deeper infection that might require another operation.
Blood clots (leg or lung) – There is small risk of developing a blood clot after foot surgery. Measures are taken to reduce the chance of this happening but cannot be completely avoided.
Chronic regional pain syndrome – Following foot surgery a small proportion of patients can develop chronic regional pain syndrome. Your foot becomes indefinitely painful, swollen and sensitive. If you develop this, you may require specialist care from a pain consultant.
What happens after my operation?
When will I go home after surgery?
Most patients can go home on the same day of surgery. You may require an overnight hospital stay in hospital if you have other significant medical problems.
Can I walk on the foot?
After the operation you will be provided with a surgical sandal to wear. This protects the operated area and allows you to fully weight bear through the operated leg. Before you go home the physiotherapist will make sure you are safe to get around on crutches. In the first few weeks keep your leg elevated as much as possible to help reduce the swelling and aid wound healing. It is important that your bandage remans dry and you may find using a waterproof cover helpful (www.limboproducts.com).
When will I be followed-up in clinic?
You will be seen two weeks after surgery in the outpatient clinic. Your wounds will be checked, and the stitches removed. If the wound has healed, you can then start wearing your own footwear. An accommodative soft trainer is best. You will be referred to our specialist physiotherapists. You will then be seen again six weeks after surgery to check on your progress.
When can I go back to work?
If you have a sedentary job (desk based) and are able to elevate your foot, you can return to return to work two weeks after surgery. If you have a more physically strenuous job, you may need longer off work.
When can I drive?
You can start driving when you are comfortably walking in your own footwear. If you cannot safely make an emergency stop your insurance will not cover you in the event of an accident. Start by sitting in the car and trying the pedals, then drive round the block. Drive short distances before long ones.
When can I return to full activity levels?
It varies how quickly people can take up exercise again. You should though avoid high impact exercises for at least six weeks and return gradually as your comfort levels allow.
When can I fly after surgery?
If you are flying after recent surgery you are at an increased risk of developing a blood clot in one of the deep veins in your body, usually the leg (deep vein thrombosis or DVT). Please ask your surgeon for individual guidance on how long to delay flying after your surgery. Also, each airline has its own regulations about flying after surgery and you will need to check with your airline before flying.
Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.
Taking vitamin C supplements for six weeks before surgery and six weeks after surgery can also be beneficial. You can purchase them from your local pharmacy or supermarket.
If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.
We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.