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Hallux Limitus/Rigidus
Cheilectomy Procedure

Cheilectomy Procedure.

The operation can be performed comfortably under a local anaesthetic block, which is achieved with a series of injections around the ankle. You can remain fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain.

The operation takes about 30 minutes, although you will be in the day surgery unit for some time before the surgery and afterwards, to allow you an opportunity to rest post-operatively. You must have a competent adult at home for the first day and night after surgery. This allows us to be sure you will be safe for the first night.

Aims of Surgery

  • To reduce pain and deformity.
  • To improve the movement and alignment of the big toe.
  • To reduce callus/corn formation.

Advantages of this Operation

  • Joint-preserving procedure that may improve the range of movement at the joint.

Specific Risks of this Operation

  • Joint stiffness.
  • Arthritis in the same or other joints.
  • Transfer of pressure to the ball of the foot.
  • Recurrence of symptoms.
  • Damage to nerves, tendons, or blood vessels.
  • Delayed or non-union of bone (bone does not knit together).
  • Problems with fixation (screws/plates/pins).
  • Elevation of the first metatarsal.
  • Shortening of the big toe.
  • Potential need for further surgery.
  • Deep vein thrombosis or pulmonary embolism.

Operation Time

Usually takes about 30 minutes.

Incision Placement/Stitches

Incision is made on the top side of the foot, using absorbable stitches where possible.

Procedure

  • Removal of bony outgrowths and joint debris to improve joint motion and decrease pain.
  • A prosthetic joint implant may be inserted, and one or two bones may be cut and reset.

Fixation

Sometimes a screw and implant are used. The surgeon will explain this further during your consultation.

Will I Have Plaster?

No, you will be provided with a special shoe to wear.

Is This a Day Procedure?

Yes, you will go home the same day (you may be admitted for up to 8 hours).

Estimated Time Off Work

  • Non-manual work: approximately 2–4 weeks.
  • Manual work: approximately 4–6 weeks.

Indications for the Procedure

  • Arthritis of the big joint of the first toe.
  • Pain from the prominent joint.
  • Difficulty with shoe fit, despite wearing sensible footwear.

Alternative Treatments

  • Manage symptoms by altering activity levels, using painkillers and anti-inflammatories, changing footwear, using an insole or orthotic foot support, or joint injection therapy.
  • Other surgical procedures include 1st MTP joint fusion, excisional arthroplasty, or decompression osteotomy.

Patient Reported Outcomes

  • 93% reduction in pain; Cartiva patients have experienced nearly the same substantial reduction in pain as fusion patients.
  • Cartiva patients demonstrate long-lasting, substantial improvement in foot function.
  • Approximately 10% of patients may require a cortisone injection 6 months after the surgery to settle the joint, and less than 2% of patients may require revision surgery (usually fusion).

Post-Operative Care

First 2–4 days after surgery

  • This is the time you are likely to have the most pain, but you will be given painkillers to help. You must rest completely for 2–4 days.
  • You will be able to stand and take weight on your operated foot after the operation, but you must rest, with your feet up, as much as possible.
  • You should restrict your walking to going to the bathroom, the sofa and to bed.
  • You can get about a little more after 3 days.

1 week after surgery

  • You will need to attend an appointment for your foot to be checked and, if necessary, redressed.

Between 2–4 weeks after surgery

  • The bandages will be removed if all is proceeding well and you will be allowed to start walking in normal shoes.

Between 4–8 weeks after surgery

  • If all has gone well you will be able to start wearing a good lace-up shoe/trainer.
  • The foot will still be swollen and twinges of discomfort are not uncommon at this time due to you increasing your activity.
  • You will be instructed regarding rehabilitation exercises or you may be referred to a physiotherapist.
  • You may return to non-manual work but may need longer if you have an active job.
  • You may return to driving if you can perform an emergency stop. You must check with your insurance company and Mr. Cichero before driving again. You may return to work but may need longer if you have an active job.

Between 12–16 weeks after surgery

  • The foot should continue to improve and begin to feel normal again.
  • There will be less swelling.
  • Sport can be considered depending on your recovery.

6 months after surgery

  • The swelling should now be slight and you should be getting the full bene t of surgery.

12 months after surgery

  • The foot has stopped improving with all healing complete.

Please note, if a complication arises, recovery may be delayed.

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For more information, questions or queries, please email us or call 01872 392087.

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