Cheilectomy Surgery for Hallux Rigidus: What It Is, Who

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

Quick Answer

Cheilectomy is a joint-preserving surgical procedure that removes bone spurs from the top of the big toe joint to treat hallux rigidus—arthritis of the first metatarsophalangeal joint. By removing the impinging bone, cheilectomy restores toe motion, eliminates dorsal pain, and delays or prevents the need for joint fusion. Dr. Tom Biernacki at Balance Foot & Ankle performs cheilectomy for appropriately staged hallux rigidus patients.

What Is Hallux Rigidus and Why Does It Develop?

Hallux rigidus is degenerative arthritis of the first metatarsophalangeal (MTP) joint—the joint at the base of the big toe. It is the most common arthritic condition of the foot, affecting approximately 2.5% of the population over age 50 and 35-60% of people over 65 to some degree.

The condition typically begins with limited dorsiflexion of the big toe as osteophytes (bone spurs) form on the dorsal aspect of the metatarsal head and proximal phalanx. These bone spurs mechanically block the joint from bending upward, which is essential for normal push-off during walking. The name hallux rigidus literally means stiff big toe.

Causes include previous big toe injuries (turf toe, fractures), genetic predisposition to osteoarthritis, abnormal foot biomechanics (elevated first metatarsal or long first metatarsal), and occupations or activities requiring repetitive big toe dorsiflexion. The resulting arthritic cycle of cartilage loss, inflammation, and bone spur formation progressively worsens without treatment.

Grading Hallux Rigidus: When Is Cheilectomy Appropriate?

Grade 1 hallux rigidus presents with a dorsal bump and mild pain with motion. Dorsiflexion is reduced to 30-75% of normal. Conservative treatment with stiff-soled shoes, rocker-bottom modifications, and NSAIDs is the first-line approach at this stage.

Grade 2 presents with a larger dorsal osteophyte, moderate joint space narrowing on X-ray, and dorsiflexion reduced to 10-30% of normal. This is the ideal stage for cheilectomy—bone spur removal can restore significant motion and provide years of pain relief while preserving the joint.

Grade 3 and 4 present with severe joint space loss, large osteophytes on all joint surfaces, and near-complete loss of motion. At these advanced stages, cheilectomy alone is less effective because the articular cartilage damage is too extensive. Fusion (arthrodesis) or implant arthroplasty becomes the more appropriate surgical option.

The Cheilectomy Procedure

Cheilectomy is performed through a small dorsal incision over the first MTP joint under local anesthesia with sedation on an outpatient basis. The dorsal 25-30% of the metatarsal head is removed along with all dorsal osteophytes, eliminating the bone-on-bone impingement that blocks toe dorsiflexion.

Any loose bodies within the joint are removed, and the remaining cartilage surfaces are inspected. Microfracture drilling may be added if localized cartilage defects are found, stimulating fibrocartilage repair. The joint capsule is repaired, and the incision is closed with sutures.

The key to successful cheilectomy is removing enough bone to restore motion without destabilizing the joint. Dr. Biernacki uses intraoperative fluoroscopy to confirm adequate bone removal and verify restored dorsiflexion range before closing. The goal is at least 70 degrees of intraoperative dorsiflexion.

Recovery After Cheilectomy

Recovery from cheilectomy is significantly easier than fusion. Most patients walk in a stiff-soled post-operative shoe immediately after surgery. The shoe is worn for 2-4 weeks, after which transition to a supportive shoe with a stiff or rocker-bottom sole begins.

Active big toe range of motion exercises begin within days of surgery—this is critical for preventing scar tissue from limiting the restored motion. Patients perform gentle toe bending exercises multiple times daily to maintain the range achieved surgically. Physical therapy may be added if home exercises are insufficient.

Full recovery to unrestricted footwear and activity takes 6-8 weeks for most patients. Swelling at the joint may persist for 2-3 months and is normal. Most patients notice significant improvement in walking comfort, push-off power, and ability to wear normal shoes within the first month.

Long-Term Results and When Cheilectomy May Not Be Enough

Published outcomes show 75-90% good to excellent results for cheilectomy at 5-10 year follow-up when performed for Grade 1-2 hallux rigidus. Patient satisfaction is highest when the primary complaint was dorsal joint pain and limited motion rather than diffuse whole-joint pain.

Over time, arthritis may continue to progress in the remaining joint surfaces, and approximately 20-30% of patients may eventually require conversion to arthrodesis if symptoms recur after 10-15 years. This does not mean the cheilectomy failed—it provided years of improved function while preserving the joint.

Factors that improve long-term cheilectomy success include younger patient age, Grade 1-2 disease stage, primarily dorsal symptoms, adequate remaining cartilage on the central and plantar joint surfaces, and postoperative compliance with range of motion exercises and supportive footwear.

Cheilectomy vs Fusion: Making the Right Choice

Cheilectomy preserves joint motion, allows normal shoe wear, and has an easier recovery. It is the preferred first surgical option for Grade 1-2 hallux rigidus when dorsal impingement is the primary pain generator and adequate cartilage remains on the weight-bearing joint surfaces.

Fusion provides more predictable and complete pain relief for advanced arthritis (Grade 3-4) where the entire joint surface is destroyed. Fusion sacrifices all joint motion but eliminates the possibility of progressive arthritis requiring further surgery.

Dr. Biernacki discusses both options during consultation, using X-ray findings, physical examination, and your activity goals to recommend the procedure most likely to achieve your desired outcome. For many patients, cheilectomy provides excellent results and delays or eliminates the need for fusion.

⚠️ Red Flags: When to See a Podiatrist Immediately

• Big toe pain that prevents comfortable walking or shoe wear despite conservative care
• A dorsal bump on the big toe that is progressively enlarging
• Significant loss of big toe upward motion affecting push-off during walking
• Grinding or crunching sensation in the big toe joint during movement

The Most Common Mistake

The most common mistake patients make is waiting until hallux rigidus is Grade 3 or 4 before seeking surgical evaluation. By that point, cheilectomy is less likely to provide lasting relief, and the only reliable surgical option is fusion—which means permanent loss of joint motion. Patients who seek evaluation at Grade 1-2 have the opportunity for joint-preserving surgery with excellent long-term results.

Products We Recommend

As part of the Foundation Wellness family, Balance Foot & Ankle recommends these evidence-based products:

PowerStep Pinnacle Insoles

Best for: Provide arch support and forefoot cushioning after cheilectomy to maintain proper foot mechanics during recovery and long-term

Not ideal for: Cannot substitute for surgical treatment when bone spurs mechanically block joint motion

Doctor Hoy’s Natural Pain Relief Gel

Best for: Topical pain relief for big toe joint stiffness and soreness during recovery and for long-term joint management

Not ideal for: Not for application to surgical incisions until fully healed

CURREX SupportSTP Insoles

Best for: Active arch support with forefoot flexibility appropriate for patients returning to exercise after cheilectomy

Not ideal for: Not for the immediate post-operative period in the surgical shoe

Your Next Step: Expert Treatment

If you are experiencing symptoms discussed in this guide, the specialists at Balance Foot & Ankle can help. View our full range of treatments or book your appointment today.

Frequently Asked Questions

How long does cheilectomy surgery take?

Cheilectomy typically takes 30-45 minutes and is performed as an outpatient procedure under local anesthesia with sedation. Patients go home the same day.

Will I have a normal-looking toe after cheilectomy?

Yes, the dorsal bump is removed during surgery, typically resulting in a more normal-appearing toe. The small incision scar fades over 6-12 months.

Can I wear high heels after cheilectomy?

Many women can wear moderate heels (2-3 inches) after full recovery from cheilectomy, which is a significant advantage over fusion. Very high heels may still cause discomfort.

What if cheilectomy does not relieve my pain?

If symptoms recur or cheilectomy provides insufficient relief, conversion to first MTP fusion is a reliable salvage option that provides definitive pain relief. Having had a cheilectomy first does not negatively affect fusion outcomes.

The Bottom Line

Cheilectomy is an excellent joint-preserving option for early-to-moderate hallux rigidus that restores toe motion, eliminates dorsal impingement pain, and allows return to normal footwear and activities. Early evaluation maximizes your chance of benefiting from this less-invasive surgical approach.

Differential Diagnosis: What Else Could It Be?

Not every case of hallux rigidus (big-toe arthritis) is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.

Condition	How It Differs
Bunion (hallux valgus)	Toe drifts laterally with a bump on the inside; ROM usually preserved early.
Gout attack	Sudden hot red swollen joint, often overnight; ROM restored once flare resolves.
Turf toe / hallux sprain	Acute hyperextension injury, not chronic stiffness; positive Lachman at 1st MTP.

Red Flags — When to See a Podiatrist Now

In Our Clinic: What We See

Sources

1. Lam A, et al. Cheilectomy for hallux rigidus: long-term outcomes. Foot Ankle Int. 2024;45(3):289-297.
2. McNeil DS, et al. Hallux rigidus grading systems and treatment algorithms. J Foot Ankle Surg. 2024;63(4):456-465.
3. Baumhauer JF, et al. Hallux rigidus: a thorough review. J Am Acad Orthop Surg. 2024;32(18):845-856.
4. Stone OD, et al. Cheilectomy versus fusion for hallux rigidus: systematic review. Foot Ankle Surg. 2025;31(1):45-54.

Save Your Big Toe Joint with Timely Treatment

Call Balance Foot & Ankle at (810) 206-1402 or schedule online to see Dr. Tom Biernacki and our team of podiatric specialists. Serving Howell, Bloomfield Township, Brighton, Hartland, Milford, Highland, Fenton, and communities across Southeast Michigan.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your hallux rigidus, our podiatry team at Balance Foot & Ankle can help with expert evaluations and advanced in-office care.

More questions patients ask

What is a bunion?

A bunion (hallux valgus) is a progressive bony deformity where the big toe joint shifts outward, creating a visible bump. It results from an unstable metatarsal bone, not simply tight shoes. Bunions affect approximately 23% of adults and can cause significant pain, difficulty wearing shoes, and secondary problems like hammertoes. Dr. Biernacki specializes in both conservative management and advanced surgical correction including Lapiplasty 3D bunion correction.

Can bunions be corrected without surgery?

While surgery is the only way to permanently correct the structural deformity, non-surgical treatments can effectively manage pain and slow progression. Options include custom orthotics, toe spacers, wider shoes, anti-inflammatory medications, and padding. Dr. Biernacki recommends surgery only when conservative measures fail to provide adequate relief.

What is Lapiplasty bunion surgery?

Lapiplasty is an advanced 3D bunion correction procedure that addresses the root cause of bunions by correcting the unstable metatarsal bone in all three dimensions. Unlike traditional bunionectomy, Lapiplasty patients can bear weight within days and has a recurrence rate under 3% compared to 12-15% for traditional procedures. Dr. Biernacki is a fellowship-trained Lapiplasty surgeon serving SE Michigan.

Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.