A cheilectomy is surgery to remove bone spurs and excess bone from the top of your big toe joint, giving the toe enough space to bend again. It’s the most common joint-preserving surgery for hallux rigidus, a form of osteoarthritis that makes the big toe progressively stiff and painful. The procedure is typically an outpatient surgery, meaning you go home the same day.
Why the Big Toe Gets Stiff
Hallux rigidus, which literally translates to “stiff big toe,” is osteoarthritis of the joint where your big toe meets the foot (the metatarsophalangeal joint, or MTP joint). Over time, the cartilage in this joint wears down, and the body responds by growing extra bone along the edges. These bony overgrowths, called bone spurs, crowd the top of the joint and physically block the toe from bending upward. That motion matters more than you might think: every time you walk, climb stairs, or push off during a run, your big toe needs to flex about 50 to 90 degrees.
Early on, you might notice pain only during certain activities. As the condition progresses, even walking in flat shoes becomes uncomfortable, and you may feel a hard bump on top of the joint. A cheilectomy addresses this by shaving away the bone spurs and removing roughly the top third of the metatarsal head, reopening the space the toe needs to move.
Who Is a Good Candidate
Hallux rigidus is graded on a scale from 1 to 4, based on how much cartilage remains and how large the bone spurs have grown. Cheilectomy works best for Grade 1 and Grade 2 cases, and selected Grade 3 cases where more than half the cartilage on the metatarsal head is still intact. For Grade 4, or Grade 3 cases where less than 50% of the cartilage remains, surgeons generally recommend a joint fusion (arthrodesis) instead.
That said, some surgeons have pushed the boundaries. A combination of cheilectomy with an additional bone-cutting procedure on the toe (a proximal phalangeal osteotomy) has shown an 85% patient satisfaction rate even in advanced cases with extensive joint degeneration. Your surgeon’s recommendation will depend on imaging, how much motion you still have, and your goals for activity afterward.
What Happens During Surgery
Cheilectomy is performed through an incision on the top of the big toe joint. The surgeon exposes the joint, identifies the bone spurs crowding the dorsal (top) surface, and removes them along with the upper third of the metatarsal head. This creates a smooth, rounded surface with more clearance for the toe to bend upward. The incision is then closed with stitches, and the foot is bandaged.
The procedure typically uses regional anesthesia (a nerve block that numbs the foot) rather than general anesthesia, though practices vary. Surgery usually takes under an hour. A newer minimally invasive version uses smaller incisions and specialized instruments to achieve the same bone removal through tiny portals, which may reduce some soft tissue disruption.
Cheilectomy vs. Joint Fusion
The biggest advantage of cheilectomy over joint fusion is that it preserves motion. Fusion (arthrodesis) permanently locks the big toe joint in a fixed position. It’s highly effective at eliminating pain, but you lose the ability to bend the toe entirely. That means no high heels, limited ability to sprint or jump, and a permanent change to your gait.
Cheilectomy aims to reduce pain while keeping the joint functional. You maintain the ability to push off the ground naturally, wear a wider range of footwear, and return to activities that require toe flexibility. One case study published in a surgical journal highlighted a patient whose work in fashion required high-heeled shoes. After a cheilectomy, she was pain-free and back in court-style heels and sports by 12 weeks. Fusion would not have allowed that.
The tradeoff is durability. Cheilectomy doesn’t replace lost cartilage or stop osteoarthritis from progressing. If the joint continues to deteriorate, you may eventually need a second surgery, potentially including fusion. The overall revision rate for cheilectomy is about 7.4%.
Recovery Timeline
Most people can put some weight on the foot immediately after surgery, though you’ll likely wear a stiff-soled surgical shoe for the first few weeks to protect the joint. Swelling peaks in the first week and gradually subsides over the following month or two. Stitches typically come out around two weeks.
The key to a good outcome is early, gentle motion. Bending and flexing the toe (within your comfort range) prevents scar tissue from forming in the joint space you just created. Most surgeons recommend starting these exercises within days of surgery. Transitioning back to normal shoes usually happens around 4 to 6 weeks, and return to sports or high-impact activities is realistic by 8 to 12 weeks, depending on how your healing progresses.
Risks and Complications
Cheilectomy is a relatively low-risk procedure, but complications occur in about 11% of cases. The most common issue is residual pain, affecting roughly 7.5% of patients who undergo the traditional open approach. This can happen if the arthritis was more advanced than imaging suggested, or if not enough bone was removed.
Nerve irritation or injury is the other notable risk, occurring in about 3.8% of minimally invasive procedures (and less often with the traditional open approach, where the surgeon has better visibility of the nerves). This can cause numbness or tingling on the top of the toe, which usually improves over several months but can occasionally persist.
Infection, stiffness from scar tissue, and recurrence of bone spurs are all possible but uncommon. The minimally invasive approach has a slightly lower overall complication rate (about 9.7% vs. 11.7% for traditional), though its revision rate is modestly higher (8.8% vs. 6.1%), possibly because the limited visibility makes it harder to remove all the problematic bone in one pass.
What Results to Expect
Most patients see meaningful improvement in both pain and function. In studies measuring patient-reported outcomes, functional ability scores improved from around 65 out of 100 before surgery to approximately 85 out of 100 afterward. That’s a significant jump, roughly the difference between limping through daily activities and walking comfortably again.
The realistic expectation is less pain and more motion, not a completely normal joint. You’ll likely have more range of motion than before surgery, but probably not as much as a toe that was never arthritic. The joint still has some degree of cartilage loss, and over years, the arthritis may progress. For many people, though, cheilectomy buys years or even decades of comfortable function before any further intervention is needed.