First MTP Cheilectomy

What is the first MTP?

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint.

What is a first MTP cheilectomy?

A first MTP cheilectomy removes bone spurs on the top surface of the big toe joint bones. Bones spurs develop with arthritis (hallux rigidus) of the big toe, and spurs act as a mechanical block to motion, which causes pain.  

X-ray showing a bone spur on the big toe joint.

What are the goals of a cheilectomy?

This goal of this procedure is to relieve pain. Range of motion may be improved.

What signs indicate surgery may be needed?

Patients have pain with limited motion of the big toe. You may have pain with direct pressure from shoewear. Prior to undergoing surgery, you may try nonsurgical methods, such as wearing a stiff shoe, an insert and/or medications. If you do not have relief of symptoms with these, a cheilectomy may be right for you.

When should I avoid surgery?

Hallux rigidus is a progressive, arthritic condition. If your arthritis is more severe, a cheilectomy may not be the appropriate surgery.

General Details of Procedure

The spurs on the top of the bones are removed and the joint is cleaned out. Any free-floating debris in the joint is removed. This may allow the joint to have more range of motion and decrease pain with walking and standing.

Specific Technique

An incision is made over the top of the first metatarsophalangeal joint. Care is taken to avoid the tendon that extends the big toe. Any bone spurs are removed. If there is inflamed joint tissue or debris, these are removed as well. The cartilage on the joint surfaces is inspected. Approximately 30 percent of the top portions of the head of the metatarsal bone and corresponding bone spurs are removed.

What happens after surgery?

After the surgery, your foot is put in a soft dressing. Your doctor will encourage you to keep your foot elevated for a few days after surgery to minimize swelling. The sutures will be removed once the wound has healed. As the swelling goes down, you will be able to transition back into a regular shoe. Your doctor may have you start performing range of motion exercises on the toe. 

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
With a cheilectomy, there is always a risk of numbness along the big toe, a painful scar or an incision that does not heal properly. Arthritis is a progressive problem, and you may have continued arthritis pain despite surgery. Some patients may even need later surgery, such as a fusion. This can occur in 20 to 30 percent of patients with big toe arthritis.

Frequently Asked Questions

Are there any metal or implants put in my foot?
No. The goal of a cheilectomy is just to remove the bone spurs. No hardware is put into the toe.
What if my arthritis gets worse?
Most patients do well with a cheilectomy for more than 10 years. If your arthritis progresses, other options to consider are joint fusion and joint interpositional arthroplasty​.
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