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

What Is Cheilectomy?

Cheilectomy — from the Greek word for “lip excision” — is a surgical procedure that removes the dorsal osteophytes (bone spurs) that accumulate on the top of the first metatarsal head and the base of the proximal phalanx in hallux rigidus, the arthritic condition of the big toe joint. By removing these osteophytes, the surgery restores the range of dorsiflexion motion that is blocked by their presence, relieving the pain that occurs when the toe is forced upward during push-off in walking, running, and stair climbing.

At Balance Foot & Ankle, cheilectomy is performed as a joint-preserving procedure for patients with mild to moderate hallux rigidus — grades 1 and 2 of the four-grade classification system. Patients with end-stage hallux rigidus (grade 3 to 4 with severely narrowed joint space and diffuse cartilage loss) are more appropriately treated with first MTP joint fusion (arthrodesis), which provides more reliable long-term pain relief when the articular surface is globally destroyed.

What Causes the Bone Spurs of Hallux Rigidus?

Hallux rigidus is degenerative arthritis of the first metatarsophalangeal joint, caused by cartilage breakdown at the joint surface. As articular cartilage deteriorates, the body responds by forming bone spurs — osteophytes — at the margins of the joint. On the dorsal (top) surface of the first metatarsal head, these spurs grow directly into the path of the extensor tendon and the proximal phalanx during dorsiflexion, mechanically blocking the motion needed for normal push-off. This impingement produces the characteristic pain with toe extension that defines hallux rigidus.

Risk factors include prior big toe joint injury, foot mechanics that overload the first MTP joint (particularly a long first metatarsal or a rigid plantarflexed first ray), and hereditary predisposition to joint degeneration.

Who Is a Candidate for Cheilectomy?

The ideal cheilectomy candidate has grade 1 or 2 hallux rigidus with pain primarily from dorsal osteophyte impingement — pain with toe extension rather than generalized joint pain with all motion. Clinical examination demonstrates preserved passive dorsiflexion when the osteophytes are manually compressed out of the path of motion, and X-rays show adequate residual joint space (greater than 50 percent of normal) with osteophytes localized primarily to the dorsal joint margin.

Patients with generalized joint line pain in all directions of motion, advanced radiographic changes with diffuse joint space narrowing, and grade 3 to 4 disease are better served by arthrodesis. Attempting cheilectomy in advanced disease leads to persistent pain and high revision surgery rates. Patient selection is the most critical determinant of cheilectomy success.

Surgical Technique

Cheilectomy is performed under ankle block local anesthesia with or without sedation as an outpatient procedure. A dorsomedial incision over the first metatarsophalangeal joint provides access to the dorsal osteophytes while avoiding the extensor tendon and neurovascular structures.

The dorsal capsule is incised and the joint surfaces exposed. Osteophytes are removed from the dorsal metatarsal head using a small oscillating saw and rongeurs — typically removing 20 to 30 percent of the dorsal metatarsal head with the osteophyte, providing adequate clearance for toe dorsiflexion. Additional osteophytes on the dorsal base of the proximal phalanx are similarly removed. Lateral and medial osteophytes may also be addressed if they contribute to impingement or joint stiffness.

After osteophyte removal, the surgeon confirms passive dorsiflexion of at least 70 to 90 degrees under anesthesia. The capsule is loosely closed, and the skin is approximated with absorbable sutures. A soft, compressive dressing is applied without casting.

Recovery After Cheilectomy

Weight bearing in a surgical shoe begins immediately after surgery. The shoe is worn for two to three weeks while the incision heals. Early range of motion exercises — gentle passive dorsiflexion of the toe performed several times daily beginning at 48 to 72 hours postoperatively — are critical for preventing scar contracture and maintaining the surgical gain in motion. Physical therapy focusing on first MTP range of motion, scar mobilization, and gait retraining begins at two to three weeks.

Transition to regular athletic footwear typically occurs at three to four weeks. Return to running and high-impact activities is expected at six to ten weeks for most patients. The final result — including complete swelling resolution and maximum functional improvement — is assessed at six months.

Outcomes

Cheilectomy produces good to excellent results in 70 to 80 percent of appropriately selected patients (grade 1 to 2 hallux rigidus) at short to medium-term follow-up. Pain with walking and shoe wearing is significantly reduced, and dorsiflexion is improved by an average of 20 to 30 degrees. The procedure does not halt the underlying degenerative process — hallux rigidus will continue to progress at its natural rate after cheilectomy. Many patients require additional treatment — repeat cheilectomy or conversion to arthrodesis — 10 to 15 years after the initial procedure as disease progresses. This expected progression should be clearly discussed with patients preoperatively so that expectations are appropriately calibrated.

Frequently Asked Questions

Cheilectomy Surgery in Michigan

Cheilectomy removes bone spurs from the big toe joint to restore motion and reduce pain in early-to-moderate hallux rigidus. Our podiatric surgeons perform cheilectomy at our Howell and Bloomfield Hills offices.

Learn About Big Toe Joint Surgery | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Coughlin MJ, Shurnas PJ. Hallux rigidus: grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85(11):2072-2088.
2. Easley ME, et al. Isolated subtalar arthrodesis. Foot Ankle Int. 2000;82(5):613-624.
3. Feltham GT, et al. Cheilectomy for hallux rigidus. Foot Ankle Int. 2001;22(6):431-436.

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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.