The first metatarsophalangeal (MTP) joint, colloquially known as the big toe joint, can fall prey to bone spurs due to hallux rigidus or arthritis, hindering toe mobility and causing discomfort. A first MTP cheilectomy emerges as a surgical solution, aiming to excise these spurs and restore toe functionality while alleviating pain.
Symptoms
Limited big toe motion or discomfort exacerbated by shoe pressure may signal the need for surgery. Before opting for surgical intervention, non-surgical measures like stiff shoes, rigid inserts, anti-inflammatory medications, or injections should be explored. Surgery becomes a consideration when these conservative methods fail to mitigate pain effectively.
Treatment
During a first MTP cheilectomy, Dr. Kamel meticulously removes bone spurs atop the metatarsal and phalanx bones of the big toe, simultaneously clearing any debris within the joint. This procedure aims to augment toe range of motion and alleviate pain during weight-bearing activities. Importantly, no metallic implants or hardware are introduced into the foot during the procedure.
Specific Technique
This procedure is done through minimally invasive techniques; two small incisions are made on either side of the first MTP joint, ensuring the avoidance of the extensor tendon of the big toe. Bone spurs are excised, along with any inflamed joint tissue or debris. Inspection of joint cartilage follows, with approximately 30% of the top portions of the metatarsal bone and corresponding spurs removed to enhance joint function.
Recovery
Post-surgery, the foot is dressed in a soft dressing, with elevation recommended to reduce swelling. Full weight-bearing is typically permissible immediately after surgery, facilitated by a post-operative shoe or walking boot. Sutures are removed upon incision healing, often accompanied by range-of-motion exercises for the toe. Transitioning back to regular footwear usually occurs within 2-4 weeks as swelling subsides.
Risks and Complications
Surgical procedures have inherent risks, those include: those associated with anesthesia, infection, and nerve or vessel damage. Risks specific to cheilectomy are potential numbness along the big toe, painful scarring, or delayed incision healing. The specific technique with minimal incisions significantly reduces the risk of scarring and greatly improves incision healing rates. Despite surgical intervention, arthritis progression may persist, necessitating future procedures like fusion, wherein joint cartilage is removed and the big toe bones are fused together. This secondary surgery may be required in 20-30% of patients with big toe arthritis, albeit offering prolonged relief for many individuals.
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