Diseases and Surgical Procedures

Cheilectomy

Cheilectomy is a surgical procedure to remove a bony lump (made up of bone spurs) on the top of the main joint of the big toe. The bone spurs are almost always caused by degenerative arthritis of the big toe (sometimes known as "Hallux Rigidus"). Sometimes an injury to the cartilage covering the end of the big toe will set the degenerative motion in process and eventually lead to Hallux Rigidus.

Why would someone have a cheilectomy done?

This operation is performed as a treatment for degenerative arthritis, as in the case of Shaq, and when the bony spurs are pressing painfully on the shoe. Bone spurs form around the joint as part of the degenerative process. The spurs may restrict the motion in the join, especially the ability of the toe to bend upward when the foot moves forward.

What is degenerative arthritis?

Degenerative arthritis is a breakdown of the joints in the body, a wearing away of the joint itself and the connective tissue around the joint. While the cause of most forms of arthritis is unknown, there are three major factors that play a role: heredity, lifestyle and environmental factors such as overuse and/or a traumatic injury.

Who is at risk for degenerative arthritis and would be most likely to get a cheilectomy

Athletes, both amateur and professional, are at risk for degenerative arthritis. Because more young people get involved in contact sports such as soccer and rugby at an early age, more children people are developing arthritic conditions. "Young people often do not realize that they injured themselves while playing sports," says Noreen Oswell, DPM, a podiatric surgeon in private practice in Los Angeles, Calif. "Years later, that injury results in a painful, arthritic joint. Arthritis frequently affects the feet and ankles," continues Dr. Oswell, "including the big toe joint, the ankle and the area under it, and the area under the arch." Cheilectomy can prolong the active lifestyle of athletes.

What does cheilectomy involve?

The surgeon makes a cut along the top of the big toe joint over the spurs and removes the spurs so that they will not bump together when the toe extends. This allows the toe to bend better and reduces the amount of pain when walking. Sometimes the surgeon will remove a little extra bone to ensure that nothing rubs when the toe bends upward. The surgeon then flushes out the joint, stitches it up the incision and applies a dressing. The cheilectomy takes about 20-30 minutes, and is most often performed as an outpatient procedure under either local or general anesthesia. The majority of people who have a cheilectomy are able to go home the same day.

What is recovery like?

The foot is bandaged and patients are encouraged to begin gently stretching the big toe the day after surgery. As the toe heals, patients should slowly increase movement of the toe. Patients return for a checkup 1-2 weeks after surgery and then begin gentle exercises. Patients will typically be seen again 6-8 weeks after surgery. After a cheilectomy has been performed, bone spurs will almost never grow back. If the patient received the cheilectomy because of arthritis, there will most likely be an improvement in the arthritic pain within one month and movement in the joint will increase.