How is a cheilectomy done and what does recovery look like?

Dr Franz Freuler, Specialist in Orthopaedic Surgery FMH, inventor of the Hall-U-Sana® toe CPM device · U-Sana Medical AG · 27 October 2026

What is a cheilectomy?

The word comes from the Greek cheilos, meaning lip. It refers to the bony lip that forms at the edge of the joint when the big toe joint develops arthritis. When you push off, these bone spurs knock against each other, and the joint locks and hurts. The operation removes exactly this block: the spurs and the uppermost part of the joint surface of the metatarsal head, at most one third. The remaining cartilage, and with it the joint, stays.

This makes it the smallest operation that is an option for big toe arthritis. It preserves the joint, and it keeps all further options open: should the arthritis progress years later, a fusion or a joint replacement is still possible. What hallux rigidus is and which stages it has is explained in the guide to the stiff big toe.

When does a cheilectomy make sense for hallux rigidus?

It makes sense when the joint space is still clearly visible on the X-ray and the cartilage is therefore largely preserved: in grades I and II, and in selected cases of grade III, as long as more than half of the cartilage on the metatarsal head is present. The largest long-term study on this, 110 patients over a mean of 9.6 years, found predictably good results for these groups. Physically active people who want to keep their joint, and for whom non-surgical measures (stiff sole, insoles, physiotherapy) are no longer enough, benefit most.

Who is a cheilectomy not suitable for?

In grade IV, when the joint space has gone, and in grade III with less than half of the cartilage left, removing the spurs no longer helps, because the pain then comes from the damaged joint itself. Here a fusion is the reliable route. Anyone who is not prepared to move the joint every day after the operation should also discuss this with the surgeon beforehand, because the mobility gained only lasts if it is used in the first weeks.

How is a cheilectomy performed?

In most clinics the operation is done as day surgery. The anaesthetic can be a general anaesthetic, a spinal anaesthetic or an ankle block, in which only the foot is numbed locally. The anaesthetist decides together with you which option fits.

What happens in the operating theatre:

1. The surgeon makes an incision on top of or on the inner side of the big toe joint and opens the joint capsule.
2. Inflamed joint lining is removed.
3. The bone spurs on the top, inner and outer side of the joint are removed, together with 25 to 35% of the metatarsal head with the damaged joint surface.
4. The surgeon checks the movement: the aim is 70 to 90 degrees of upward movement (dorsiflexion). If that is not reached, a small wedge of bone is also removed from the first bone of the big toe, the proximal phalanx (Moberg osteotomy, in the UK also called Kessel-Bonney osteotomy), which makes the aftercare longer.
5. The capsule is stitched, the skin closed and a light compression bandage applied.

Some clinics offer the operation as a minimally invasive (keyhole) procedure: the spurs are removed through small incisions with a bone burr. Whether that fits in an individual case depends on the findings.

What does aftercare after a cheilectomy look like?

Clinics’ plans differ, above all in how long the post-op shoe is worn. The table therefore gives ranges. Which plan applies to you is set by your surgical team, and you should stick to it.

How long do you have to wear the post-op shoe?

For removal of the spurs alone, two weeks are usual, and some clinics let you put weight on the foot in a normal wide shoe as early as the day after surgery. Other centres keep the post-op shoe on as a precaution for up to six weeks. If bone was also realigned, that is a wedge removed or the metatarsal shortened, a longer plan applies: four weeks without rolling through the forefoot and an X-ray check before a normal shoe is allowed.

What should you avoid after a cheilectomy?

1. Do not drive yourself while you are wearing the post-op shoe, because you cannot operate the pedals safely in it. When you can drive again is decided by your surgeon, usually once the foot can bear full weight in a normal shoe. In the UK, also check with your motor insurer.
2. Do not stretch forcefully against the pain. The exercises are gentle, and mobility comes through repetition.
3. Keep water away from the wound until the stitches are out.
4. Do not start sport too early: light activity from about week 10, running and hiking much later, after discussion with your surgeon.
5. Do not spend the whole day on your feet. Swelling is normal in the first weeks and goes down faster if you keep the foot up.

Which exercises are important after a cheilectomy?

The goal of the operation is mobility. That is why aftercare is not a time of rest but a time of movement. The reason lies in the joint: after any operation, the joint capsule tends to stick together. Even one week of immobilisation shortens the joint lining and leads to adhesions (Akeson et al. 1987). If you instinctively keep the operated joint still, you lose part of what the surgeon has just gained.

Gentle exercises from the first day are therefore usual: guide the toe carefully up and down with your hand, without force, within the pain-free range, several times a day. A common plan specifies twice 10 minutes a day for six to eight weeks. Physiotherapy also mobilises the joint, works against the swelling and later retrains your walking. Twelve sessions are a usual course. There is also a study on passive motion, carried out after hallux valgus surgery: 39 patients after a chevron (Austin) correction were divided into two groups, and 21 of them used a motorised continuous passive motion (CPM) device for eight hours a day over 24 days from the day of surgery, in addition to physiotherapy. Their joint was more mobile at every follow-up visit, and they returned to normal shoes and stopped taking painkillers sooner (Connor et al. 1995). The study used a different device from the one described below. The studies are on the studies page.

How long does a cheilectomy take to heal?

The wound has healed after about 12 days. Depending on the plan, everyday walking in a normal shoe works again after two to six weeks. Swelling takes the longest: until the third, sometimes the fourth month, a thicker foot in the evening is normal. It can take three to six months until the joint makes full use of its new mobility and daily life runs without holding back. In the long-term studies, upward movement of the toe increased on average from 14.5 to 38.4 degrees.

How long will I be off work after a cheilectomy?

That depends on your job and on the plan. The figures given by clinics in Germany vary widely:

The short values apply to removal of the spurs alone with early weight-bearing, the long ones to plans with a long period in the post-op shoe or to jobs that make heavy demands on the foot. If you can work from home with your foot up, you are often back early. The journey to work counts too: do not drive yourself while you are wearing the post-op shoe.

What are the risks of a cheilectomy?

It is a routine operation, and it has the usual risks of any foot surgery: delayed wound healing, infection, a blood clot (thrombosis), numbness on the inner side of the toe if a skin nerve is irritated, and swelling that can last up to four months. In a German long-term study of 60 patients, 4 had permanent numbness and 3 had delayed wound healing; none needed a second operation.

Two risks are specific to this procedure. If too little bone is removed, the block remains; if too much is removed, the big toe joint can become unstable. Both depend on the experience of the surgeon, which is one reason to choose an experienced foot and ankle surgeon. And the arthritis itself continues. The spurs can re-form over the years; the effect lasts in the medium term, in the studies for many years, but not forever. Rarely, patients feel that the joint is worse after the operation than before.

What do patients experience after a cheilectomy?

We do not reproduce individual reports here, because the figures from long-term studies are more meaningful. The American study covering 19 years of practice (Coughlin and Shurnas 2003) found a subjectively good or very good result in 97% of patients; 92% of the operations were successful in terms of pain and function. In the German study from Hanover (Waizy 2010), 86% of the patients who had spur removal alone were satisfied or very satisfied after eight years; in grade I, 78% had no more pain, in grade II 74%.

What people typically experience: the first two weeks are dominated by swelling, keeping the foot up and changes of dressing. Mobility grows over weeks, not days, and it grows with the exercises. A swollen foot in the evening unsettles many people, but it is normal into the third month. And for most people the pain when pushing off, which accompanied every step before the operation, goes early on.

Conclusion

Cheilectomy is the small, joint-preserving operation for the early stages of hallux rigidus: usually day surgery, with early weight-bearing and good long-term figures. What it achieves is decided in the weeks afterwards. If you move the joint gently every day from the first day, take the post-op shoe and keeping your foot up seriously, and wait with sport and driving until your surgeon gives the go-ahead, you will usually keep the mobility gained.

---