Cheilectomy: A guide for patients

A cheilectomy (ky-lec-toe-me) is the name given to a procedure where prominent bony outgrowth on the top of the first metatarsal, which is the long bone of the big toe joint, is removed. Corresponding bony projections on the sides of the metatarsal and from the base of the big toe bone are also removed.

Bony prominence can often cause pain when the big toe jams against it or footwear rubs on it.

You usually recover quickly following this procedure as no screws, wires or plates are required. You will usually be able to return to a lace-up shoe once the stitches have been removed although, if other procedures are also carried out, the recovery may be longer.

Following a cheilectomy there is often an increase in the movement of the big toe joint. If, however, there is arthritis in the big toe joint, this increased movement can sometimes produce pain, which may not have been present before the operation.

About day case surgery under local anaesthetic

Surgery is carried out under local anaesthetic as a day case. This means that you are awake during the operation but a screen will prevent you from seeing the surgery.

To numb your foot you will either be given some injections around your ankle or behind the back of the knee. You can eat and drink on the day of surgery; there is no need for fasting.

The operation may take up to 40 minutes, but you should be prepared to be at the hospital for some time before the surgery and afterwards to allow for preparation and recovery.

You will be invited back to attend a pre-surgical clinic if you decide on surgical management. A member of the nursing team will take a medical history. If you are on any medication, please bring a list with you. This is a good opportunity to ask questions and discuss any concerns you may have about the procedure.

You must have a competent adult at home for the first day and night after surgery.

Recovery after your operation

The first two to three days

• You must rest with your foot elevated to hip level.
• You should restrict walking to bathroom visits only. If you have been given crutches you must use them in the way shown. You may be able to bear a little weight on the foot.
• You should take the prescribed painkillers. If you experience pain, it is usually worse for the first two days.
• If you are still experiencing pain after three to four days that is not relieved by the painkillers you should contact the podiatric surgery department.
• If you have any concerns over your foot you should contact the podiatric surgery department.
• The department is closed at the weekend. Out-of-hours, you should contact your GP or go to your local accident and emergency (A&E) hospital.

Two weeks after surgery

• Two weeks after the operation you must attend for your stitches to be removed.
• You should no longer need a bandage and should be able to wear a normal shoe again. This shoe does need to be roomy because your foot will be quite swollen; ideally a running lace-up type trainer. If you do not have any you will need to buy some before the surgery. You do not need to spend a lot of money on this shoe.
• You can normally start bathing the foot one to two days after the stitches have been removed.
• At this stage, you can gradually and gently increase your activities. You will still need to rest between your activities.
• You will also be given a rigorous regime of exercises to regain strength and flexibility in the toe joint.

Between two and six weeks after surgery

• During this time the foot gradually returns to normal and you may be able to vary your footwear.
• There will still be noticeable swelling especially towards the end of the day. This is quite normal at this stage.
• Three weeks after surgery you can begin driving; however, you must feel able to perform an emergency stop. Please check with your insurance company about when your policy covers you to drive.
• You may return to work about three to four weeks following surgery. However, for jobs that require you to be on your feet for an extended period of time this may be unrealistic expectation.
• Although normal everyday activities will be possible, sporting activities are still restricted at this stage.
• You can return to sporting activities and gym work at about four weeks.

Between six and 12 weeks after surgery

• The foot should now be comfortable and returning to normal but there may still be some slight swelling.

Six months after surgery

• The residual swelling should now be very slight, although the healing process continues for a year. You should be getting full benefit from the surgery.

12 months after surgery

• All healing is now complete.

Frequent or serious risks

All operations carry a small risk of complications. In foot surgery complications are uncommon and most resolve without permanent disability or pain. General and specific complications of this procedure include:

• infection (two in 100)
• delayed healing of the skin (eight in 100)
• non-compliance of patients (four in 100)
• prolonged swelling post operatively (four in 100)
• thick or sensitive scar formation (four in 100)
• the toe may become stiff which could affect the heel height of the shoes you wear (one in 100)
• progression of the bony swelling or arthritic symptoms
• blood clot deep vein thrombosis (DVT).

Complications following foot surgery are rare events but can occur. It is important to remember that if a complication arises you will be required to visit the hospital more frequently and there could be a significant impact on your recovery pathway and return to work time. Foot surgery should be avoided if it is for cosmetic gain.