Minimally Invasive 1st MTPJ Cheilectomy

Introduction

Metatarsophalangeal joint (MTPJ) is a junction between the metatarsal bones (long bone in the foot) and proximal bones (bone in toes). 1st MTPJ refers to the joint in the big toe of the foot. Cheilectomy is a surgery to remove excessive bone from the 1st MTPJ. The operation is performed through a very small incision which is why it is referred to as minimally invasive. This surgery is intended to treat pain and stiffness and to increase the motion in the joint of the big toe.

Indication

Cheilectomy is designed to treat early arthritis and hallux rigidus. The surgery is performed to treat pain, stiffness and limited range of motion in the joint of the big toe which is caused due to arthritis.

Pre-operative care

Before surgery, the details of your medical history will be collected. Your doctor might recommend you to undergo an X-ray examination. If necessary, you might also be advised to get a CT-scan done.

Surgical procedure

The surgery is carried out as a day-case procedure (no over-night stay in the hospital) and under general anaesthesia. A single 2cm incision or small keyhole incision is made on the top of the big toe. The excessive bone or build-up of bone at the joint, which blocks the normal movement of the toe, is excised and the skin is sutured with dissolvable stitches. In rare cases, the surgeon might recommend an additional surgery where 2 keyholes are made at the base of the big toe in order to align the joint. The procedure will be carried out under live X-ray guidance (fluoroscopy) and the surgeon may insert screws for stabilization of the alignment.

Post-operative care

At the end of the operation, a local anaesthesia is injected in the ankle to provide post-operative pain relief for almost 10 hours. Your foot will be dressed with a bandage that will be removed after 7 days. You will be asked to keep your foot in an elevated position and take anti-inflammatory medications to minimize swelling. A surgical shoe is worn for 1 week initially after surgery to avoid infection. The physiotherapists will guide you with mobilisation exercises to reduce muscle tightness after which you will be able to walk gradually and resume daily activities. You will be advised not to drive a vehicle for 3 weeks and not to wear high heels for 6-8 weeks.

Risks and Complications

Risks associated with cheilectomy are:

• Infection
• Swelling
• Slow wound healing
• Nerve damage
• Deep vein thrombosis

Around 80% of the people who have undergone cheilectomy have found it to be effective and safe.