Decompression Osteotomy for Hallux Rigidus

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Patient Guide · Foot & Ankle Surgeon · London & North London

Decompression Osteotomy for Hallux Rigidus

A patient guide to joint-preserving big toe arthritis surgery

Written by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon · Last reviewed 7 September 2026

Hallux rigidus is the medical name for arthritis of the big toe joint (your surgeon may call it the first MTP joint). It causes pain, stiffness, and a bony bump on top of the joint that catches in shoes and limits how far the toe can bend. A decompression osteotomy is an operation that eases this pain while keeping your toe moving, instead of permanently stiffening the joint (a fusion). This guide explains why the surgery is offered, how to prepare, what it involves, and what recovery looks like. It has been prepared by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon in London and North London.

At a glance

  • Typically a day-case operation, home the same day
  • Removes the painful bony spur and takes pressure off the arthritic joint
  • Preserves big toe movement — unlike a fusion
  • Back into a normal shoe by around 6 weeks; full activity by around 3 months

Contents

  1. Why have the surgery? (Benefits and indications)
  2. Preparing for the surgery
  3. What does the surgery involve?
  4. How long will you be in hospital?
  5. What does recovery look like?
  6. What are the risks?
  7. Frequently asked questions
01

Why have the surgery? (Benefits and indications)

When the cushioning cartilage of the big toe joint wears away, the bones begin to rub and the body forms bony spurs around the joint (your surgeon may call these osteophytes). The spur on top of the joint gets in the way and pinches as the toe bends upwards, which is why pushing off, kneeling, squatting, wearing certain shoes, and sport can become painful. This is called hallux rigidus, or big toe arthritis.

Most people are helped first with non-surgical measures — supportive or stiff-soled footwear, activity changes, painkillers or anti-inflammatories, and occasionally a steroid injection. Surgery is considered when these have been tried for several months and pain still limits daily life.

The main benefit: keeping your joint moving

For advanced arthritis, fusing the joint — stiffening it permanently so that it no longer bends, an operation called an arthrodesis — has long been the most reliable way to relieve pain, but it takes away all movement in the big toe. A decompression osteotomy is designed to ease the pain while keeping the toe moving, in patients who are suitable for it. By removing the spur and moving the bone to take the pressure off the joint, it stops the pinching that causes the pain and lets the toe carry on bending.

Published evidence is encouraging. In a recent study comparing the two operations, people who had a decompression osteotomy got as much pain relief and were just as satisfied as those who had a fusion (about 9 in 10 people were happy with the result in both groups), but they kept more movement in the toe and had fewer complications. Other studies that followed patients for more than ten years found the improvement lasted, and very few people went on to need a fusion later. Keeping the joint moving can also make kneeling, using stairs, choosing shoes, and getting back to sport and active hobbies easier.

You may be a candidate if you have

  • Persistent big toe arthritis pain that has not settled with at least a few months of non-surgical treatment
  • Pain coming mainly from the bony spur on top of the joint, and stiffness when you bend the toe upwards
  • A wish to keep some movement in the joint rather than fuse it
  • Enough healthy joint space still showing on your standing X-rays or weight-bearing CT scan

The right choice is always one we make together with you, taking into account how severe your arthritis is, what you like to do, and what matters most to you.

02

Preparing for the surgery

Good preparation makes recovery smoother. Before the day, you will have a consultation and up-to-date imaging (X-rays and often a Weight-Bearing CT scan) so the plan is tailored to your foot. If you smoke, stopping beforehand helps the bone heal. Let the team know about your medications, as some (such as blood thinners) may need adjusting.

Because you will need to keep your foot raised up for much of the first two weeks, a few simple items bought in advance make a real difference:

  • A foam leg elevator — a wedge that comfortably supports your whole leg above the level of your heart, which helps keep the swelling down
  • A waterproof cast/dressing protector (for example the “Limbo” cover) so you can shower without getting the dressing wet

Please also arrange time off work, help at home for the first week or two, and a lift home after surgery, as you will not be able to drive.

For a full checklist, please read our Preparing for Foot Surgery leaflet. Our Product Guide lists the recommended elevator, cast protector and other helpful items.

03

What does the surgery involve?

The operation is usually done as a day case — either while you are asleep under a general anaesthetic, or with an injection that numbs the foot and leg so you feel nothing. It takes around an hour.

Two steps in one operation

Through a small cut on the inner side of the big toe, the surgeon first removes the bony spur from the top of the joint — this step is called a cheilectomy — so the bones no longer catch on each other. A precise angled cut is then made in the long bone just behind the joint (this cut is the osteotomy). The end of the bone is moved slightly backwards and downwards, which takes the squeeze off the joint and relaxes the tissues around it. Taking the pressure off the worn surfaces is what relieves the pain and lets the toe bend more freely.

The bone is held in its new position with one or two tiny screws that are buried beneath the surface. They usually stay in for good and you should not feel them. The skin is closed with stitches, a supportive dressing is put on, and you are given a stiff-soled shoe to wear afterwards.

04

How long will you be in hospital?

This is almost always a day-case procedure, meaning you come in and go home on the same day, once you are comfortable, have eaten and had a drink, and the team is happy you can manage safely at home. Occasionally an overnight stay is arranged — for example if surgery is late in the day or for medical reasons — but most patients are home within a few hours.

05

What does recovery look like?

Recovery is gradual, and we will guide you through it step by step. Everyone heals at a slightly different pace, so we will confirm your own timeline at your follow-up appointments.

Early (0–2 weeks)

  • Keep the foot raised up as much as possible — this is where the foam leg elevator earns its keep — to settle swelling and pain
  • Walk short distances in the stiff-soled shoe, putting your weight through the heel and the outer side of the foot rather than the toe
  • Keep the dressing clean and dry (use your waterproof cover for showering)
  • Stitches are usually removed at around 2 weeks

Mid-term (2–6 weeks)

  • Keep wearing the flat surgical shoe for about 6 weeks while the cut bone heals
  • Begin gentle toe-bending exercises — guided by us or a physiotherapist — to keep the joint moving; this is central to a joint-preserving operation
  • Gradually increase how much you walk and how much weight you put through the foot, as comfort allows
  • Around 6 weeks, most people move into a roomy trainer once healing is confirmed

Long-term (6 weeks–6+ months)

  • Return to most everyday activities and low-impact exercise as comfort and strength return
  • Return to sport and more demanding activity is usually around 3 months (12 weeks), or once the bone has fully healed
  • Driving is possible once you can walk comfortably and safely control the car — often around 6–8 weeks for a right foot, sooner for a left foot in an automatic
  • Some swelling and stiffness can take several months to settle fully, and the final result can take up to a year to come through
06

What are the risks?

Decompression osteotomy is a well-established operation with a good safety record, and studies comparing it with fusion have found fewer complications. As with any surgery, though, it is not risk-free. The risks that relate most closely to this operation are:

  • Ongoing or recurrent pain and stiffness — the arthritis is eased, not cured, and can progress over time; a small number of patients may later need further surgery, including conversion to a fusion
  • New pain under the neighbouring toes, because weight shifts across the front of the foot — uncommon, and studies of this operation have not generally found it to be a problem
  • The cut bone healing slowly, or not joining fully — uncommon, and more likely if you smoke
  • Mild shortening of the toe, which is part of how the operation works and is rarely troublesome
  • Irritation from the screws — unusual, as they are buried; occasionally one is removed later

General risks that apply to most foot surgery — such as infection, wound-healing problems, blood clots, nerve irritation, a tender scar and complex regional pain syndrome (a rare condition causing long-lasting pain and swelling) — are explained in detail in our Guide to the Risks of Forefoot Surgery. We will discuss the risks relevant to you before you consent to surgery.

07

Frequently asked questions

Will I still be able to move my big toe afterwards?

Yes — preserving movement is the whole purpose of a decompression osteotomy. By removing the spur and decompressing the joint, the operation aims to let the toe bend more freely than before, which is the key difference from a fusion.

Is this better than a fusion?

Neither is simply “better” — they suit different situations. A fusion gives very predictable, permanent pain relief but no joint movement. A decompression osteotomy offers comparable pain relief and satisfaction while keeping the joint moving, which many active people value. The best option depends on your X-rays, your activities and your preferences, decided together.

How long will I need off work?

A desk-based job is often possible from around 2 weeks, provided you can keep the foot elevated. Jobs that involve standing, walking or manual work usually need 6 weeks or more.

When can I drive again?

Once you can walk comfortably without the surgical shoe and safely do an emergency stop — commonly around 6–8 weeks for right-foot surgery, and often sooner for a left foot in an automatic car.

When can I get back to sport?

Most people return to running and sport at around 3 months, once the bone has healed and strength has returned. If you have a particular sport or goal in mind, we will tailor your rehabilitation to it.

Will the screws need to be removed?

Usually not. The screws are small and buried beneath the bone surface, so most people never feel them. Removal is only occasionally needed.

Can both feet be done at the same time?

Generally we operate on one foot at a time, so you always have one comfortable foot to stand and walk on during recovery.

What happens if it doesn’t relieve my pain?

A fusion remains available as a reliable option later if needed, so a joint-preserving operation does not “burn any bridges.”

Next step

Speak to a specialist

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon based in London and North London, with a specialist practice covering big toe and forefoot arthritis, sports injuries, complex reconstruction and total ankle replacement, supported by Weight-Bearing CT. To discuss whether a decompression osteotomy is right for you, please book an appointment.

Book a consultation

Call 07547 395 270 or email secretary@matthewwelck.com.

Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London
This guide provides general information and is not a substitute for individual medical advice.

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