Hallux Limitus/Rigidus
Cheilectomy Procedure (+/- Cartiva Implant)

Procedure

Cheilectomy Procedure (+/- Cartiva Implant).

Aims of surgery

To reduce pain and deformity.
To improve the big toe movement & alignment.
To reduce callous/corn formation.

Advantages of this operation

Joint preserving procedure, which 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.
Nerve/tendon/blood vessel damage. Delayed/Non-union of bone (bone does not knit together).
Fixation problems (with the screws/plates/pins). Elevation of the 1st metatarsal.
Shortening of the big toe.
Further surgery.
Deep Vein Thrombosis/Pulmonary Embolism.

Operation time

Usually takes about 30 minutes.

Incision placement/stitches

Top side of the foot and with absorbable stitches where possible.

Procedure

Remove the bony outgrowths and joint debris which should improve joint motion and decrease pain.
A prosthetic joint implant may or may not also be inserted and one or two bones cut and reset.

Fixation

Yes – sometimes a screw and implant is used. The surgeon will explain this further at the time of your consultation.

Will I have a plaster

No. You will be provided with a special shoe to wear.

Is this a day procedure?

Yes, you can usually go home the same day (you could 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 your symptoms by altering activity levels, using painkillers and anti-inflammatories, changing footwear, using an insole or orthotic foot support, joint injection therapy. Other surgical procedures including 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 down, and less than 2% of patients may require revision surgery (usually fusion).

More information

Speak with your consultant.

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. If you do not wish to consider having the operation performed whilst still awake, or your Consultant does not feel this is the best option for you, you will be offered local anaesthetic with sedation or general anaesthesia.

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.

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