Cheilectomy

Cheilectomy is a surgical procedure that removes dorsal bone spurs and, in some cases, a portion of the dorsal metatarsal head at the first metatarsophalangeal joint (the big toe) to relieve impingement and improve motion. It is most commonly used to treat early-stage hallux rigidus or dorsal impingement that limits dorsiflexion and causes pain, and it may be performed as an outpatient operation.

Indications include mild to moderate hallux rigidus (often grades I–II) with painful dorsal impingement and reduced range of motion despite conservative treatment. Contraindications include advanced arthritis with significant joint incongruity, severe deformity, or instability of the first MTP joint, where fusion or joint replacement may be more appropriate.

The procedure is typically performed under regional anesthesia with sedation or general anesthesia. A dorsal approach exposes the joint, and the surgeon removes the dorsal osteophyte(s) using rongeurs and a burr, sometimes releasing the dorsal capsule to restore motion. Arthroscopic cheilectomy is also possible with small portals. The aim is to preserve cartilage while eliminating the impinging bone.

Postoperative care usually involves protection with a boot or cast and gradual weight bearing as tolerated, followed by a structured range-of-motion program. Most patients experience pain relief and improved dorsiflexion in the early stages, though long-term outcomes are better in early disease and may be limited if arthritis is advanced or osteophytes recur.

Risks include infection, wound healing problems, stiffness, persistent pain, recurrent osteophyte formation, and nerve irritation. Alternatives include conservative management, osteotomy, or, for more advanced disease, arthrodesis (fusion) or joint replacement.