What Is a Cheilectomy?

A cheilectomy is a surgical procedure that removes bone spurs (osteophytes) from the top (dorsal surface) of the first metatarsophalangeal (MTP) joint — the big toe knuckle — to relieve pain and restore dorsiflexion motion limited by hallux rigidus. The procedure removes the prominent dorsal lip of bone that impinges against the base of the proximal phalanx when the toe bends upward, eliminating the painful bone-on-bone contact that limits push-off during walking and running.

At Balance Foot and Ankle, our foot surgeons perform cheilectomy as the preferred surgical treatment for mild to moderate hallux rigidus, preserving the joint and allowing patients to maintain natural big toe motion.

Who Is a Candidate for Cheilectomy?

Cheilectomy is most appropriate for patients with Grade 1 or Grade 2 hallux rigidus — significant dorsal bone spur formation with painful limitation of dorsiflexion but at least 50 percent of normal joint space preserved on X-ray. The presence of adequate remaining cartilage is the key indicator of suitability. Patients who retain reasonable cartilage but have pain and motion loss primarily from bone spur impingement are ideal cheilectomy candidates.

Patients with Grade 3 or 4 hallux rigidus — advanced joint space loss and circumferential arthritic change — are generally better served by joint fusion (arthrodesis) or total joint replacement rather than cheilectomy alone, as the remaining cartilage cannot support long-term function.

The Surgical Technique

A longitudinal incision is made over the dorsal surface of the first MTP joint. The joint is exposed and the dorsal bone spur is removed using an osteotome and rongeur. Typically 25 to 30 percent of the dorsal metatarsal head is resected. The joint is then taken through a range of motion intraoperatively to confirm adequate dorsiflexion has been achieved — a minimum of 70 degrees of dorsiflexion is the surgical goal. Any loose bodies within the joint are removed. The capsule and skin are closed in layers.

Recovery After Cheilectomy

Patients bear weight in a surgical shoe or postoperative sandal immediately after the procedure. Most patients transition to a wide athletic shoe within 2 to 3 weeks as swelling permits. Physical therapy beginning at 2 to 3 weeks focuses on regaining dorsiflexion range of motion and normalizing gait. Return to athletic activity typically occurs at 6 to 12 weeks depending on the activity demands. Swelling in the foot can persist for 3 to 6 months following any forefoot procedure.

Outcomes and Long-Term Considerations

Cheilectomy provides excellent pain relief and meaningful restoration of dorsiflexion in appropriately selected patients. Studies report satisfactory outcomes in 70 to 90 percent of patients with Grade 1 and 2 hallux rigidus at intermediate follow-up. The procedure does not address the underlying arthritic process, however, and some patients experience gradual progression of arthritis over years requiring additional treatment. Patients who require surgery again are candidates for joint fusion or arthroplasty at that time.

If you have big toe pain and stiffness that limits your activity, contact Balance Foot and Ankle for evaluation. Our foot surgeons serve patients throughout Southeast Michigan with same-week appointments available.

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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.