1st dorsal cheilectomy

Dorsal cheilectomy
Summary

This operation is performed for symptoms caused by arthritis of the 1st metatarsophalangeal joint, also known as hallux rigidus.  This joint is the “knuckle” joint of the big toe.  Increasing pain and stiffness occurs as the joint surfaces get damaged.  The body produces increased bone (osteophytes) to stiffen the joint further.  Osteophytes can impinge against each other causing further pain, particularly when standing on tiptoes or “toeing off” when walking.  Surgery involves removing the osteophytes causing the impingement to try and reduce the pain.  It does not, however, treat the arthritis.

Factors to Consider

You have been diagnosed with hallux rigidus. It is likely that you have already tried non-surgical treatments for your foot such as pain killers, footwear modification, physiotherapy and injections.  

If these measures have not improved your symptoms then the next logical step is to consider surgery.  A dorsal cheilectomy is a good operation for patients whose main problem is pain on bending their toe back.  This is most often done when standing on tiptoes or walking.  If pain is experienced through all movements of the toe then a  1st MTPJ fusion or a Cartiva procedure may be a better surgical option.  Your surgeon will discuss what the best option for your foot would be. 

Description of Surgery

The operation is usually performed through a minimally invasive (keyhole) approach.  Open surgery is required for more severe cases.  The osteophytes on the top of the joint are removed.  

The operation takes about 30 minutes.

Anaesthetic

The operation is usually performed under a general or spinal anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is that it doesn’t fully resolve your symptoms.  The operation is treating a consequence of the arthritis but not treating the arthritis itself.  Therefore, your symptoms can return or may not fully resolve.  

The risk of infection is small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Any surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a bandage.  This can be reduced in the first few days following surgery.  Your surgeon will recommend the use of a rigid soled shoe for the first one to two weeks.  You can then start wearing normal supportive footwear.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks from surgery.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 2-4 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that “it takes 3 months to be fair, 6 months to be good and 12 months to be right”.