Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is a Cheilectomy?

A cheilectomy (from the Greek word for lip) is a surgical procedure that removes bone spurs (osteophytes) from the dorsal (top) surface of the first metatarsophalangeal (MTP) joint — the joint at the base of the great toe. These spurs form as the joint degenerates in hallux limitus and hallux rigidus, and their mechanical presence is a primary driver of the pain and restricted motion that characterizes these conditions.

By removing the offending bone prominences, cheilectomy creates space for the great toe to dorsiflex (bend upward) more freely, relieving the impingement pain that occurs at end range of motion.

Who Is a Good Candidate?

Cheilectomy is most effective for Grades 1 and 2 hallux rigidus (mild to moderate), where the primary problem is dorsal osteophyte formation rather than diffuse cartilage loss throughout the joint. Ideal candidates have:

• Pain localized to the top of the joint, particularly at end range of dorsiflexion
• Preserved joint space on X-ray (indicating cartilage remains viable beneath the spurs)
• Pain responsive to stiff-soled shoes that limit dorsiflexion (confirming the impingement mechanism)
• Failed conservative treatment for 6 months

Patients with Grade 3–4 disease (severe diffuse cartilage loss, panarticular degeneration) are better served by arthrodesis (fusion) or joint replacement, as cheilectomy alone is unlikely to provide lasting relief when the underlying cartilage is extensively damaged.

The Surgical Procedure

Cheilectomy is typically performed as an outpatient procedure under regional anesthesia (ankle block or popliteal nerve block). A dorsal incision is made over the first MTP joint, the joint capsule is opened, and the dorsal osteophytes are removed using a bone saw and rongeur. Typically, the dorsal 25–30% of the metatarsal head is removed to create adequate decompression. Any loose bodies within the joint are also removed.

Some surgeons augment cheilectomy with microfracture of exposed cartilage defects to stimulate fibrocartilage healing, or with Moberg osteotomy (proximal phalanx dorsiflexion osteotomy) to further improve functional dorsiflexion range of motion.

Recovery

Cheilectomy recovery is among the most straightforward of foot surgeries:

• Days 0–2: Elevation and limited walking in a post-op shoe
• Weeks 1–3: Walking in a comfortable stiff-soled shoe; swelling and stiffness are expected
• Weeks 3–6: Range of motion exercises — critical to achieving and maintaining the improved motion gained surgically
• Weeks 6–12: Return to athletic footwear and most activities
• Months 3–6: Full recovery; residual stiffness resolves gradually

Early, consistent toe range of motion exercises are essential — the joint must be moved through its new range while healing to prevent scar tissue from limiting the improvement gained intraoperatively.

Outcomes

For appropriately selected patients, cheilectomy achieves good to excellent results in 70–80% at medium-term follow-up. Improvement in pain and range of motion is typically maintained at 5 years. Progressive joint disease may eventually require conversion to arthrodesis in 10–20% of cases, but many patients enjoy a decade or more of improved function before further intervention is needed.

The relatively simple recovery, preservation of joint motion, and low complication rate make cheilectomy an attractive first-line surgical option for patients with Grade 1–2 hallux rigidus who want to avoid fusion.

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Big Toe Arthritis Surgery in Michigan

Cheilectomy removes bone spurs from the big toe joint to restore motion and reduce pain in hallux limitus and early hallux rigidus. Dr. Tom Biernacki performs this joint-preserving procedure at Balance Foot & Ankle.

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Clinical References

1. Coughlin MJ, Shurnas PS. “Hallux rigidus: grading and long-term results of operative treatment.” J Bone Joint Surg Am. 2003;85(11):2072-2088.
2. Feltham GT, et al. “Long-term results of cheilectomy for the treatment of hallux rigidus.” Foot Ankle Int. 2001;22(6):462-470.
3. McNeil DS, et al. “Operative treatment of hallux rigidus.” Foot Ankle Int. 2013;34(1):15-32.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.