Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Balance Foot & Ankle Specialists
Last Updated: April 2026 · Reading Time: 7 min
In This Guide
The most important clinical decision with Cheilectomy Surgery Hallux Rigidus Bone Spurs Big Toe isn’t which treatment to start with — it’s which subtype or underlying cause you actually have. That distinction changes everything. Call us: (810) 206-1402
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.
Watch: Stiff Big Toe Joint Pain(Hallux Rigidus) TREATMENT [Exercises, Taping] — MichiganFootDoctors YouTube
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.
⚠ Important: Cheilectomy is most effective for early-stage hallux rigidus. If cartilage damage is severe (grade 3–4), a joint fusion or implant may be more appropriate. Accurate staging with X-rays is essential before choosing the right procedure.
More Podiatrist-Recommended Arthritis Essentials
Cushioned Running Shoe
Hoka Clifton 10 — max cushioning reduces joint impact for arthritic feet.
Wide Walking Shoe
New Balance 990v6 — wide toe box accommodates arthritic first-MTP (hallux rigidus).
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Foot and ankle arthritis progresses silently — cartilage doesn’t regrow, but joint fusion, cheilectomy, and biologic injections can restore function at every stage. Balance Foot & Ankle offers the full arthritis spectrum: bracing, injections, and reconstructive surgery. Start with a consult so we can image the joint and give you a realistic 5-year outlook.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Township
Frequently Asked Questions
How long does a cheilectomy take?
Cheilectomy typically takes 30–60 minutes as an outpatient procedure under local or regional anesthesia. Most patients go home the same day and begin gentle range-of-motion exercises within a few days.
Can bone spurs grow back after cheilectomy?
Some bone spur regrowth can occur over time, especially if the underlying arthritis progresses. Studies show 75–90% of patients maintain good results at 5+ years. Wearing stiff-soled orthotics can help slow recurrence.
When can I walk normally after cheilectomy?
Most patients walk in a surgical shoe immediately after surgery and transition to regular supportive shoes by 3–4 weeks. Full recovery with return to sports and high-impact activities typically takes 8–12 weeks.
What is the difference between cheilectomy and big toe fusion?
Cheilectomy preserves joint motion by removing bone spurs, while fusion (arthrodesis) permanently locks the joint for severe arthritis. Cheilectomy is preferred for milder cases because it maintains flexibility, though fusion provides more reliable pain relief for advanced disease.
Recommended Post-Surgical Products
These products support recovery after cheilectomy surgery:
- BraceAbility Walking Boot – Post-surgical protection during initial healing. Check price on Amazon
- Powerstep Pinnacle Orthotics – Stiff-soled support for post-recovery footwear. Check price on Amazon
- TheraBand Foot Roller – Gentle massage for post-surgical rehabilitation. Check price on Amazon
As an Amazon Associate we earn from qualifying purchases. Product selection is based on clinical relevance.
The Bottom Line
Cheilectomy is an effective, joint-preserving option for hallux rigidus patients with mild to moderate bone spur formation. When performed at the right stage, it provides reliable pain relief and restores big toe motion without the limitations of joint fusion. Consult a board-certified podiatric surgeon to determine if cheilectomy is appropriate for your hallux rigidus stage.
Big Toe Joint Pain or Stiffness?
Dr. Biernacki specializes in cheilectomy and hallux rigidus treatment at Balance Foot & Ankle Specialists.
Schedule Your Consultation →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 Township offices.
Learn About Big Toe Joint Surgery | Book Your Appointment | Call (810) 206-1402
Clinical References
- Coughlin MJ, Shurnas PJ. Hallux rigidus: grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85(11):2072-2088.
- Easley ME, et al. Isolated subtalar arthrodesis. Foot Ankle Int. 2000;82(5):613-624.
- Feltham GT, et al. Cheilectomy for hallux rigidus. Foot Ankle Int. 2001;22(6):431-436.
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4330 E Grand River Ave
Howell, MI 48843
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43494 Woodward Ave, Suite 208
Bloomfield Township, MI 48302
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More Hallux Rigidus / Big-Toe Arthritis Guides from Dr. Tom
- First MTP Joint Fusion (Arthrodesis) for Hallux Rigidus: The Gold Standard for Severe Big Toe Arthritis
- Hallux Rigidus: Grading, Conservative Treatment, and Surgical Options — Cheilectomy vs. Fusion
- Cartiva Synthetic Cartilage Implant for Hallux Rigidus: Motion-Preserving Alternatives to Fusion
Need treatment? Learn about in-office hallux rigidus / big-toe arthritis treatment at Balance Foot & Ankle, or call (810) 206-1402 for same-week appointments.
