Cheilectomy — surgical resection of the dorsal osteophyte (bone spur) at the first metatarsophalangeal (MTP) joint — is the most commonly performed procedure for hallux rigidus (degenerative arthritis of the first MTP joint) in active patients with Grade 1–2 disease, where adequate remaining articular cartilage exists and joint preservation is the goal. When appropriately indicated, cheilectomy reliably relieves the dorsal impingement pain characteristic of hallux rigidus, improves dorsiflexion, and allows return to athletic activity — with 80–90% patient satisfaction and durability of 7–10+ years before additional intervention may be required.

Anatomy, Staging, and Patient Selection

Hallux rigidus staging (Coughlin-Shurnas classification): Grade 1 — mild dorsal osteophytes, <50% joint space loss, dorsiflexion 40–60°, pain only at extremes of motion; Grade 2 — moderate osteophytes, 25–50% joint space loss, dorsiflexion 10–40°, pain through arc of motion; Grade 3 — severe osteophytes, 50–75% joint space loss, dorsiflexion 10–30°, significant impingement pain; Grade 4 — advanced — loss of plantar joint surface cartilage; Grade 5 — no remaining cartilage (arthroplasty or arthrodesis required). Cheilectomy is appropriate for Grades 1–2 and selected Grade 3 patients where central joint cartilage remains viable. The critical assessment is the plantar cartilage — if central or plantar articular cartilage is destroyed, cheilectomy alone fails in 30–40% of cases and arthrodesis provides more reliable results. Surgical technique: dorsomedial incision over the first MTP joint; extensor hallucis longus tendon mobilization; dorsal capsulotomy; resection of the dorsal 20–30% of the metatarsal head including all visible dorsal osteophytes; additional osteophyte resection from the dorsal proximal phalanx base; the goal is achieving 70–90° of intraoperative passive dorsiflexion after resection. Phalangeal osteotomy (Moberg): concurrent dorsiflexion osteotomy of the proximal phalanx — rotates the intact plantar articular surface into the functional weight-bearing range — extends the durability of cheilectomy in moderate disease.

Recovery and Long-Term Results

Postoperative protocol: protected weight-bearing in a postoperative shoe immediately; progressive range of motion exercises beginning at 1–2 weeks; return to athletic footwear at 4–6 weeks; return to sport at 6–8 weeks. Long-term outcomes: 8-year follow-up studies show 68–72% of patients remain satisfied without additional surgery; predictors of cheilectomy failure requiring subsequent arthrodesis include central joint cartilage loss, lateral joint space narrowing, and Grade 3+ disease at initial surgery. Revision options: first MTP arthrodesis is the gold standard revision procedure when cheilectomy fails — 95% satisfaction, excellent pain relief, maintained push-off function with appropriate surgical technique. Dr. Biernacki at Balance Foot & Ankle performs cheilectomy and first MTP arthrodesis for hallux rigidus at our Bloomfield Hills and Howell offices. Call (810) 206-1402.

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Frequently Asked Questions

Can bunions be corrected without surgery?

Bunion correctors and orthotics cannot reverse a bunion, but they can significantly reduce pain, slow progression, and improve function. Surgery is the only way to permanently correct the deformity — but conservative care often manages symptoms effectively for years.

How long does bunion surgery recovery take?

Recovery varies by procedure. Most patients are in a surgical boot for 4–6 weeks, return to regular shoes at 8–12 weeks, and are fully recovered with normal footwear at 3–6 months. Minimally invasive techniques often have faster recovery.

Do bunions come back after surgery?

Recurrence rates are low with modern surgical techniques (5–10%). Risk is reduced by wearing appropriate footwear after surgery and using custom orthotics to correct the underlying biomechanics that caused the bunion.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

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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.