Location: First metatarsal phalangeal joint (base of the great toe)
Goals of procedure: To remove arthritic spurs, to improve the range of motion and reduce pain.
Why do patients request this surgery? They request this surgery because the great toe joint becomes stiff and painful. It often becomes enlarged. This may start off after an injury from several years prior. Sometimes it is a genetic problem. Either way, over time mild arthritis becomes progressively more pronounced. One of the hallmarks is very large arthritic spurs (osteophytes) on the top of the great toe joint and sometimes the base of the great toe itself. There are often defects in the cartilage and cartilage thinning also. This may also present in combination with a more typical bunion.
How can I avoid this surgery? Wearing stiff shoes and orthotics can help. Some of our patients are also treated with synthetic joint lubricant (Supartz injections ). This is often a progressive problem over time.
Overview of surgical technique: The joint is opened up surgically and arthritic spurs are removed, a large portion of the top of the first metatarsal was also removed to improve range of motion, and defects in the joint are cleaned up the joint was flushed and repaired and sutured.
Details of surgical technique: There is a surgical incision on the top of the foot at the great toe joint (first metatarsal phalangeal joint/1rst MTP joint). The incision is deepened and capsule is identified and an incision was made within the capsule to access the joint itself. Capsule was freed from the joint to allow further exposure of the joint and full exposure of the spurs on the top of the joint. Loose fragments of bone and cartilage are removed. The large bone spurs or osteophytes on the top of the joint are removed and a portion of the top of the joint is removed also this is done with a saw and a burr. Sometimes an osteotome is utilized for this purpose. Once the bone is been resected and smoothed down it is again flushed out. Capsule is sutured to repair this. Skin and subcutaneous tissue are sutured and repaired and a dressing is placed on the wound. The patient was then placed in a cast boot.
Postop expectations: Dressing changes are done weekly and the patient is in a cast boot for the first typically 3–4 weeks postop. Patient will have postoperative pain medication initially but some of our patients have very little pain. The patient is able to put full weight on the heel and partial weight on the forefoot during the postoperative course while they are in the cast boot. The first 3-4 days after any foot surgery we recommend that the foot is elevated as possible to decrease swelling and potential discomfort. After this it is fine to be much more active with the use of the cast boot. Sutures are typically removed approximately 2–3 weeks postop or if absorbable sutures are utilized, then no suture removal is done.
Potential problems: The foot must stay clean and dry to minimize the risk of infection. It is possible to have some nerve damage although it's not common. Most "numbness" is temporary and produces or completely resolves over time. The big challenges the fact that the joint was stiff before surgery and still full often have some residual stiffness after surgery. The adaptive changes that happened to the joint over time are not completely resolved by simply removing the spurs. Over time the arthritis can continue to progress in some patients eventually need fusion of the joint.
Frequently ask questions:
-Is there bone he involved with this surgery? No, no screws or plates are utilized because the cheilectomy involves removal of spurs and a "joint clean up". The bone is not reset and there is no osteotomy or fusion involved with this procedure therefore there are no screws or implants.
-Does this surgery guarantee that I would never have other surgery or problems? The answer to this is that many patients do very well with this procedure and they're managed with orthotics and possibly the synthetic joint lubricant injections afterwards to help offer additional improvement. Some patients do have progression and require eventual fusion.
-Can I still do sports after this surgery? The answer is that your foot will be improved after the surgery for most patients. And you will have improved function of the joint. If you were able to do sports before the surgery than most patients have improvement in their activity level after surgery.