Minimally Invasive Joint Clean-Up – Cheilectomy Procedure

Arthritis of the big toe joint, also known as hallux limitus or hallux rigidus, is a common disorder that can cause significant pain and limitation in movement. There are a variety of treatment options available for this condition, both surgical and non-surgical. At District Foot and Ankle, we employ a minimally invasive approach for a surgical procedure known as a cheilectomy.

What is arthritis and why does it affect the great toe joint?

Arthritis is a general term used to describe inflammation of a joint. There are many different types of arthritis, but the most common type that affects the big toe joint is called osteoarthritis. Osteoarthritis is a degenerative condition that occurs when the cartilage that cushions the bones starts to break down. This can happen for a variety of reasons, including age, injury, or overuse. When the cartilage breaks down, it allows the bones to rub against each other, which can cause pain, swelling, and stiffness.

Arthritis is graded depending on how severe it is in the joint. As arthritis progresses, the range of motion in the joint decreases, but the extent of cartilage injury, and pain will increase. The severity of arthritis in the big toe joint will dictate what treatments can be offered from both a conservative and surgical standpoint.

Hallux limitus is a term used to describe arthritis in the big toe joint. Hallux refers to the big toe, and limitus refers to limited motion. As arthritis progresses, the motion can be significantly reduced to the point that there is essentially no motion in the joint. In this case, the condition would be referred to as “hallux rigidus “.

Reasons for arthritis to develop include wear and tear with age, trauma, gout, other inflammatory arthritis conditions, and biomechanical issues.

What is a cheilectomy?

A cheilectomy is a procedure that involves cleaning up the joint and removing painful bone spurs. Classically, the procedure has been accomplished through a large incision placed on top of the joint to expose the joint completely. A surgical saw is used to remove prominent spurs and then the large incision needs to be closed with sutures.

The advantage of the “open” approach is complete visualization of the joint. If a loose bony fragment is stuck in the joint, it can be much easier to retrieve with an open approach. If there is a focal cartilage defect (called an osteochondral lesion) it is much easier to fix through an open approach.

The disadvantage of the open approach is the amount of soft tissue dissection needed to expose the joint. This means there will be more swelling, inflammation, and scar tissue formation after the procedure heals. A larger incision is also more likely to become infected.

Through a minimally invasive approach, the joint is accessed through a small “poke” incision and a surgical bur is introduced to remove and shave the spurs. This approach offers many benefits, including shorter procedure time, less anesthesia exposure, smaller scar, less swelling and post-op pain, and less chance for scar tissue to develop after the procedure.

Will a cheilectomy work for me?

The cheilectomy can be an extremely powerful procedure but a careful evaluation pre-op is needed to make sure the patient would do well with the procedure. Patients tend to do better with this procedure with more mild-to-moderate arthritis and primarily with a painful spur on top of the joint. If a patient has pain through the ENTIRE range of motion of the joint, they will typically not do well with this procedure, they may do worse because the procedure will increase the range of motion in a joint that is painful and arthritic which may make it even more painful.

What about a joint implant replacement?

Many joint replacement procedures exist for the great toe joint. If any benefit is attained from a joint replacement, in our experience (and according to many medical and orthopedic studies), relief does not last very long. The problem with a joint replacement is that if the procedure needs to be revised, when the implant is removed, it leaves a rather large defect of bone that will require bone grafting (which is either a donated graft or graft obtained elsewhere from the patient).

How is really bad arthritis treated surgically?

For end-stage arthritis of the great toe joint, from a surgical standpoint, we recommend a fusion (arthrodesis) of the joint. With this procedure, the remaining cartilage is removed from the joint and the toe is fused/locked in an acceptable position. This is a tried and tested procedure that many people do well with including the more active population, like runners.

If you’re suffering from hallux limitus or hallux rigidus, there are a couple of options for treatment. You could try orthotics, which can help realign your toe and relieve pain. Other conservative options include corticosteroid injections, PRP injections, radial shockwave treatment, and class 4 laser treatment. Or you might opt for surgery, which can be effective in correcting the problem. Ultimately, the best course of treatment depends on your situation. At District Foot and Ankle, we specialize in minimally invasive surgery with a cheilectomy procedure that can provide significant relief from pain and limitation in movement.