Hallux Rigidus (Open 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 5cm incision on the top of the joint.
Once the spurs on the top of the bones are removed and the joint is cleaned out. Any free-floating debris in the joint is removed. This may allow the joint to have more range of motion and decrease pain with walking and standing. The cartilage on the joint surfaces can also be inspected.
Risks of surgery
Swelling & Stiffness
Initially the foot will be very swollen and needs elevating. It will be stiff in the immediate post-operative 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 will still be apparent at 6 months.
There is always a risk of infection with surgery. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for 7 days. If there is an infection, it normally resolves with a course of oral antibiotics.
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 always possible to tell prior to surgery, whether this is the case.
If there is symptomatic arthritis in this joint later, then a further operation will be necessary.
Recovery from surgery
Following surgery, the toe is protected in a specialised dressing and post-operative shoe. The dressing can be reduced to a simple elastoplast at 3 days.
Elevation of the foot (above the pelvis) for the first 7 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.
The surgery is routine, and this is one of the more minor operations. Re-cover is rapid but the swelling may last for several weeks.
- 2 weeks for removal of sutures
- 6 weeks in Foot & Ankle clinic
Activity and time off work
In general, up to 2 weeks off work is required, possibly more if your job involves a lot of physical activity such as walking and standing.