In early and middle-stage big toe arthritis, much of the pain comes from the spur on top of the joint, not from the worn joint lining (cartilage). It presses on the nerves and tendons over the toe, catches on shoes, and blocks the toe from bending up when you push off, climb stairs, kneel or run. That is why the toe can feel stiff and sore during walking and sport, and why tight or high-heeled shoes become uncomfortable.

Most people try other treatments first — roomy shoes with stiff soles, insoles, changing activities, painkillers or anti-inflammatory tablets, and sometimes an injection. We consider surgery if you have tried these and pain still gets in the way of daily life.

The main benefits

• Less pain when walking, pushing off and wearing shoes, as the bump that rubs and pinches is removed
• Better movement — the toe can usually bend upwards further than before
• Keeps your own joint — unlike a fusion (an operation that joins the bones so the joint no longer bends), a cheilectomy keeps the joint moving
• A quick recovery compared with other big toe operations, with no plaster cast and walking from day one
• Keeps options open — if the arthritis gets worse years later, other treatments, such as a decompression osteotomy or fusion, are still possible

This operation may suit you if you have

• Mild to moderate big toe arthritis with a painful bony bump on top of the joint
• Pain mainly when the toe bends up as far as it can go, rather than every time it moves
• Enough healthy joint left, as shown on X-rays or a scan taken while you stand (Weight-Bearing CT)

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 suits your foot. If you smoke, stopping beforehand helps your wound heal. Tell the team about any medicines you take, as some (such as blood thinners) may need to be changed.

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 bandage wet

Please also arrange a few days off work, some help at home for the first week, 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 leg elevator, cast protector and other helpful items.

You go home the same day (a day case). You will either be asleep (a general anaesthetic) or have an injection that numbs the foot so you feel nothing. At the end, numbing medicine (local anaesthetic) is injected around the foot, so it stays comfortable for several hours afterwards. The operation takes around 45 minutes.

The surgeon makes a cut a few centimetres long over the top of the big toe joint and gently moves the tendon and small skin nerves out of the way. Using fine instruments, the surgeon removes the bony spur, along with roughly the top quarter to third of the joint surface, where most of the wear is. Any loose bits of bone or frayed tissue are cleared, and the rest of the joint is checked. The edges of the bone are smoothed so the toe can glide upwards without catching.

There are no screws or metalwork. The skin is closed with stitches, a padded bandage is applied, and you are fitted with a flat-soled surgical shoe.

You will almost always go home on the same day as your operation — usually a few hours after surgery — once you are comfortable, have eaten and had a drink, and the team is happy you can walk safely in the surgical shoe. Sometimes we arrange for you to stay overnight, for example if your operation is late in the day or you have other health needs. You will need someone to take you home and, ideally, to stay with you for the first night.

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 bandage on, clean and dry for two weeks — use your waterproof cover for showering
• Wear the flat surgical shoe whenever you are on your feet; you can put weight through the foot straight away
• Keep the foot raised up as much as possible — this is where the foam leg elevator really helps — and only walk short distances around the home
• Take regular painkillers for the first few days, starting before the numbness from the injection wears off
• Gently bend the toe inside the bandage as much as is comfortable, to stop it getting stiff

Mid-term (2–6 weeks)

• At around 2 weeks the wound is checked, the bandage is removed and any stitches are taken out
• You can then move into soft, roomy trainers with loosened laces
• Expect swelling for 4–6 weeks; keep raising the foot in the evenings and after activity
• Do your toe-bending exercises every day — this is the key to getting the most movement back
• Walk a little further each day; most people can go back to a desk job from around 2 weeks

Long-term (6 weeks onwards)

• Most everyday activities and normal shoes are comfortable by around 6 weeks
• Gentle exercise such as cycling and swimming (once the wound has fully healed) can usually start from around 4–6 weeks, building up to running and sport by around 3 months
• Mild swelling after a busy day can linger for a few months — this is normal
• Movement and comfort continue to improve for up to 6 months

A hallux cheilectomy is a well-established operation with a good safety record. But, like any surgery, it does carry some risks. The main risks of this operation are:

• Ongoing pain or return of symptoms — the operation removes the spur but does not cure the arthritis. Around 1 in 10 to 1 in 5 people have some ongoing pain, and the arthritis can get worse over time. A small number of people later need another operation, such as a fusion
• Stiffness — movement usually improves, but we cannot promise this, especially if you do not exercise the toe in the early weeks
• Numbness or tingling on top of the big toe — from bruising of the small skin nerves near the cut; this usually gets better over weeks to months, and is rarely permanent
• Swelling that lasts a long time — normal for 4–6 weeks, and sometimes longer
• Wound problems — a small number of people get a minor wound infection, which usually clears up with antibiotics; keeping the foot raised in the first two weeks lowers this risk

These and other, less common risks are explained in more detail in our Guide to the Risks of Forefoot Surgery. We will discuss the risks relevant to you before you agree to surgery.

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 hallux cheilectomy 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.