Hallux Rigidus (MIS Cheilectomy)

Minimally Invasive Cheilectomy

This operation is for a stiff painful joint, which is minimally affected by arthritis. The name stems from the Greek word cheilos = lips, denoting the bony lips that grow on the top of the joint. The operation is to remove the obstructing 'lips'. This is performed through a tiny (3mm) incision on the side of the joint.

The surgery is routine, and this is one of the more minor operations. Recovery is rapid but the swelling may last for several weeks.

Risks of surgery

Swelling & Stiffness

Initially the foot will be very swollen and needs elevating. It will be stiff in the immediate postoperative period but movement should return rapidly (2-4 weeks). The movement should improve with surgery, but this is not always the case. The swelling will disperse over the following weeks but may still be apparent at 6 months.

Infection

There is always a risk of infection with surgery but it is very low in this type of surgery as the wound is so small. If there is an infection, it normally resolves with a course of oral antibiotics.

Nerve Injury

There is a v small nerve close to the incision, which supplies the skin to the side of the toe. This may be bruised or even permanently injured. This will leave a small patch of numbness on the side of the toe.

Continued Pain

The symptoms in this toe are due to either biomechanical abnormality in the joint (not arthritis) or they may be the first signs of arthritis in the toe. The aim of the surgery is to improve the movement in the joint and relieve pain. Overall the results from surgery are excellent.

However, if the joint has some arthritis, this may be exacerbated by the surgery and cause continued or increased pain. It is not possible to tell, prior to surgery, whether this is the case.

If symptomatic arthritis does occur joint later, then a further operation will be necessary.

Recovery from surgery

Following surgery, the toe is protected in a specialised dressing and postoperative shoe. The dressing can be reduced to a simple elastoplast at 3 days.

Elevation of the foot (above the pelvis) for the first 3 days is vitally important to prevent infection. Naturally, small periods of walking and standing are necessary.

This type of operation and the postoperative shoe allow weight bearing (walking) immediately. The postoperative shoe can be discarded once the dressings have been reduced. If ordinary footwear is still uncomfortable then a hard soled sandal is often a good idea. The swelling may take 1-2 weeks (rarely longer) to settle enough to wear normal shoes.

Driving is allowed after 3 days, only if normal shoes are worn.

Exercise and sport can start after one week, but may take 1-2 months to become comfortable.

Activity and time off work

In general, unless you have a role that involves a lot of standing, walking or other activity it is possible to return to work after a few days or a week.

Follow up

  • 2 weeks for removal of sutures
  • 6 weeks in Mr Rosenfeld's clinic