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What is a cheilectomy? If the only thing you know is that your doctor suggested a cheilectomy, here's additional information.

What Is A Cheilectomy?

You have hallux rigidus and probably don’t know anything about the treatment. You are wondering what to do and worry about the surgery. We can help you. Everything you should be aware of regarding your upcoming cheilectomy, you will find here, but if you have any concerns about your surgery talk with your surgeon! Your doctor is familiar with your case, and will know what is best for you! [1]

First, you should know that a cheilectomy is a surgery to remove a bony lump on the top of the main joint of the big toe. This problem is caused by arthritis of the big toe. Cheilectomy as a surgery increases joint movement and is successful in reducing symptoms in patients with less severe arthritis. [2]

Reasons For Cheilectomy

The first reason why doctors perform a cheilectomy is because the bony lump is pressing painfully on patient's shoes. The reason for this surgery is a treatment for early arthritis of the big toe when the joint is not yet badly affected. The most common indications for a cheilectomy are hallux rigidus in grade I or grade II without sesamoid disease.

You probably tried different shoes, before you went to a surgeon. If arthritis is your biggest problem, your doctor should advise a cheilectomy only if other treatments which include anti-inflammatory drugs, modifications to your shoes and injections have not helped.

How Is The Surgery Performed?

You shouldn’t eat, drink or smoke for 6 hours before surgery. Your surgeon will make a cut over the lump on your big toe. When he or she removes the lump, the joint will be flushed out. Your joint must be checked to find out how bad your arthritis is. After evaluation, the joint is stitched up and dressings are applied. [2]

How Long Will You Stay In The Hospital?

If you are healthy, have someone to help you after the operation, the surgery is done on an outpatient basis.

However, if you have some chronic disease such as diabetes, asthma or high blood pressure, you must stay in the hospital a day before operation, and day after the operation.

Another reason for having to stay overnight after a cheilectomy is for pain control because the surgery involves cutting out a piece of bone. You will have pain immediately after surgery. Local anesthetic injections can help with pain. The majority of people who have a cheilectomy can go home the same day.

Will You Have A General Anesthetic?

Cheilectomy can be done under general anesthetic, but it can be also done while the patient remains awake.  An injection in the back, leg or around the ankle can be done to make the foot numb. You should know that sometimes local anesthetic injections aren’t enough, and you may need a general anesthetic. Your anesthetist will suggest the best anesthetic for you. [2]

What Happens After The Cheilectomy?

After the surgery, you will have a firm bandage. After the surgery, your foot will be painful for at least a day or two, but it is usually possible to control the pain with pain killer medications. The next morning after the operation, you should remove the bandage and put an Elastoplast-type dressing over the wound. Your surgeon will explain to you how to stretch your big toe up and down gently, which can be very painful at the beginning. It is important to start moving your toe early, and as your toe heals, you should work harder and harder at it.[3]

Keep your foot elevated at the level of your heart as much as possible for the first two weeks after your surgery.

Your doctor will tell you when you should come back to the clinic, approximately 1-2 weeks after the surgery.  He or she will check your wound and advise you how to exercise. You will have another check-up about 6-8 weeks after your operation, and if everything is all right, you are officially healed. [4]

If the doctor operated because of arthritis, you will probably notice an improvement in the arthritic pain and more pain relief within a month. With cheilectomy, there is usually an increase in the movement in the joint of about 20 degrees.

It is important that you inform a doctor if you get an increase in pain after you go home, if the painkillers don’t help, this may indicate early infection.  

If you get swelling of the leg or foot which does not disappear when you elevate your foot above your heart level, you should inform your doctor.

How Soon Can I Walk Or Work?

After the surgery, for the first two weeks, your stitches and skin will heal. Your surgeon will advise you when to start exercising and initiate joint moving. You should take this seriously; you must perform rehabilitation exercises early and regularly. They are the ones that will help you achieve the best results from your surgery. 

You can walk right away after the operation. Walking helps you to avoid stiffness. You must prevent swelling of your foot, so when you're not walking, you should have your leg raised at the level of your heart. 

So, when will you be able to get back to your work? Well, that depends on what kind of a job you have. [4]

If you have your job is mostly done sitting down, you can be back to work in a few days after your surgery — with an elevated foot of course. But, if you have a heavy manual job you may be off work more than three months. If you are driving, you will be probably able to drive safely around the fourth week after the surgery. You must know you should be able to perform an emergency stop pain-free and securely. Start driving slowly and when you start to drive again don’t drive long distances at the very beginning 

When Can You Run And Exercise?

For the first two to three days have your foot elevated above the level of the heart. That means that when you're in sitting or lying position, have your foot resting on 3 to 4 pillows. You should avoid standing during the first few days after the surgery. Your doctor will give you additional advice about how to elevate your foot. You also have to know you will be probably wearing a post–operative shoe for six weeks after the surgery.

You can start exercising your foot and walking more and more each day, as the swelling in your foot goes down. You must, however, be careful! 

When you are comfortable walking, you can start gentle running and muscle stretching. Other contact and high-impact sports can follow as your comfort dictates. Everyone is different in how quickly they can take up exercise again: be guided by your own body's reactions and the advice of your surgeon. The majority of people can get back to their previous activities within six months after a cheilectomy, if not before.[5]

What Are The Possible Complications Of  A Cheilectomy?

Cheilectomy produces good results in most cases, but complications do sometimes occur. You can reduce the risk of complications by preparing yourself and your foot before surgery. The risk of complications can be slightly higher in high-risk groups, such as high blood pressure patients or diabetics. [6

Every surgery carries the potential risk of infection. You can have some discharge from the wound. If you are worried and the situation seems to aggravate, contact your doctor, especially if the discharge is accompanied by fever and general malaise. 

Don't take up exercise too soon. Damage to the small nerves and blood vessels, which are stretched, can cause numbness or tingling on top of the big toe. If you have arthritis in the joint, this may progress over the next few years, and you may eventually need further treatment. 

Weight transfer to the second toe can occur as a complication of the surgery. After this surgery, patients sometimes suffer from persisting stiffness, or their arthritis can progress. 

The complications of any surgery are complications such as thrombosis and anesthetic problems.

Most complications can be treated with medications, therapy and sometimes by additional surgery. 

In general, doctors don't support cheilectomy surgery for cosmetic reasons only. The symptoms you have before surgery must be worth the risk of potential complications. Surgery shouldn’t be done to avoid problems that are not yet present either. 

You should talk with your doctor about the potential risk of the operation, and if you have any worries, you should ask the doctor who will explain it to you well. 

Dependent upon the nature of the disease, the results are varied, with the most beneficial results in the early stages of hallux rigidus, which include symptoms, re-operation, and range of motion.