Minimally Invasive Cheilectomy of the 1st MTPJ
What is minimally invasive cheilectomy?
Cheilectomy is a procedure to remove excessive bone from the first metatarsophalangeal joint (MTPJ). The MPT joints are the junctions between the metatarsal bones (long bones in the foot) and the proximal bones (bone in toes). The first MTPJ refers to the joint in the big toe of the foot. This surgery is intended to treat pain and stiffness and to increase the motion in the joint of the big toe. It may be performed in a minimally invasive manner through a very small incision.
Indications for minimally invasive cheilectomy
Cheilectomy is designed to treat early arthritis and hallux rigidus. The surgery is performed to treat pain, stiffness and limited range of motion in the joint of the big toe which is caused due to arthritis.
Pre-operative care before minimally invasive cheilectomy
Before surgery, the details of your medical history will be collected. Your doctor might recommend you to undergo an X-ray examination. If necessary, you might also be advised to get a CT-scan done.
Surgical procedure for minimally invasive cheilectomy
The surgery is carried out as a day-case procedure (no overnight stay in the hospital) and under general anaesthesia. A single 2cm incision or small keyhole incision is made on the top of the big toe. The excessive bone or build-up of bone at the joint, which blocks the normal movement of the toe, is excised and the skin is sutured with dissolvable stitches. In rare cases, the surgeon might recommend an additional surgery where 2 keyholes are made at the base of the big toe to align the joint. The procedure will be carried out under live X-ray guidance (fluoroscopy) and the surgeon may insert screws for stabilization of the alignment.
Post-operative care after minimally invasive cheilectomy
At the end of the operation, local anaesthesia is injected in the ankle to provide post-operative pain relief for almost 10 hours. Your foot will be dressed with a bandage that will be removed after 7 days. You will be asked to keep your foot in an elevated position and take anti-inflammatory medications to minimize swelling. A surgical shoe is worn for 1 week initially after surgery to avoid infection. The physiotherapists will guide you with mobilisation exercises to reduce muscle tightness after which you will be able to walk gradually and resume daily activities. You will be advised not to drive a vehicle for 3 weeks and not to wear high heels for 6-8 weeks.
Risks and complications of minimally invasive cheilectomy
Risks associated with cheilectomy are:
- Slow wound healing
- Nerve damage
- Deep vein thrombosis
Around 80% of the people who have undergone cheilectomy have found it to be effective and safe.