First MTP Cheilectomy
The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP cheilectomy is a surgical procedure that removes bone spurs on the top surface of the big toe joint. Bones spurs develop due to arthritis of the big toe, also known as hallux rigidus. The spurs block the toe’s motion, which causes pain. A first STMP cheilectomy relieves pain and improves range of motion in the big toe.
Symptoms
Pain with limited motion of the big toe or pain with direct pressure from shoes could be signs that surgery is needed. However, patients should first try non-surgical treatments, such as wearing a stiff shoe or a rigid insert, and/or taking anti-inflammatory medications. Surgery is indicated when these efforts fail to provide good pain relief. If you do not have relief of symptoms, a cheilectomy may be right for you.
Treatment
Your foot and ankle orthopedic surgeon will remove the spurs on the top of the metatarsal and phalanx bones and clean out the joint. Any free-floating debris in the joint is removed. This may allow the joint to have more range of motion and should decrease pain with walking and standing. No metal, implants or other hardware are put in the foot.
Specific Technique
An incision is made over the top of the first MTP joint. Care is taken to avoid the tendon that extends the big toe. Any bone spurs are removed. If there is inflamed joint tissue or debris, these are removed as well. The cartilage on the joint surfaces is inspected. Approximately 30 percent of the top portions of the head of the metatarsal bone and corresponding bone spurs are removed.
Recovery
After the surgery, your foot is put in a soft dressing. Your doctor will encourage you to keep your foot elevated for a few days to minimize swelling. You normally can bear full weight on the foot immediately after surgery in a post-op shoe or walking boot. The sutures will be removed once the incision has healed. Your doctor may have you perform range of motion exercises on the toe. As the swelling goes down, you will be able to transition back into a regular shoe, usually two to four weeks after the procedure.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. With a cheilectomy, there is a risk of numbness along the big toe, a painful scar or an incision that does not heal properly. Arthritis is a progressive problem, and you may have continued pain after the surgery. While most patients do well with a cheilectomy for more than 10 years, some may need additional surgery, such as a fusion. This can occur in 20 to 30 percent of patients with big toe arthritis.
