News - BBC’s Nicholas Witchell describes his experience of minimally invasive big toe surgery, first introduced in London by LFAC surgeon.
1 February 2011
Nicholas Witchell is one of the BBC’s most renowned journalists, having worked as a news reader, reported extensively on major events and is now the Royal and Diplomatic correspondent.
Mr Witchell recently came to the London Foot and Ankle Centre for minimally invasive surgery on his arthritic big toe. The procedure is called a cheilectomy. Mr Witchell, aged 57, describes his experience of the operation and recovery. His surgeon, David Redfern explains what a cheilectomy is and how minimally-invasive techniques are used for this type of surgery.
Nicholas Witchell
“I had been having trouble with my right big toe joint for about seven or eight years. It was getting progressively worse, becoming swollen and uncomfortable. But you just think – I’ll do something about it one day. It felt much worse in the cold and there was one occasion when I found myself stumbling and knew the time had come to get it done.
“Mr Redfern told me that the arthritis was not so bad as to require orthodox surgery, leading to six weeks’ immobilisation. He said it would be possible to operate using keyhole surgery. I was not aware that it was possible to have keyhole surgery and I rather readily agreed.
“The operation was scheduled for August, which is a quiet time for me. I hadn’t been in hospital for an operation since I was eight years old and was astounded at how much anaesthesia has improved. I woke up within minutes of my operation being completed, with no after effects whatsoever, and very quickly was ready for my lunch. I left hospital by 3pm wearing a surgical shoe.
“I haven’t yet confessed this to Mr Redfern, but that same day, I then got on a bus and went into central London to help my daughter who was doing some work experience. It really was remarkable what you are able to do so soon after the operation.
“I had been given some painkillers before I left hospital, but I didn’t take any. There was a little bit of tenderness and my foot was quite bruised immediately after surgery, but there wasn’t any real discomfort at any stage. I go to the gym most mornings at 6am and was able to get back into the routine two weeks after surgery. I picked up the threads of reporting immediately and went out to Afghanistan in September.
“The surgery removed the bony growth which had developed at the top of my big toe joint – the surface is now smooth and flat. Two months after the operation, there is only a very small scar where the incisions were made, which is barely visible. I have far more flexibility and mobility and no pain in my big toe joint.
“I’m absolutely delighted with the surgery. I had no idea that this kind of surgery was available and the recovery from it is really remarkable.”
Mr David Redfern
“The big toe is a joint which moves up and down, known medically as dorsiflexion and plantar flexion. Normal movement involves being able to flex the toe upwards to approximately 75 degrees and downwards to around 25 degrees. However many people develop a stiff big toe with limited movement, called hallux rigidus. Arthritis is the most common cause of this condition and the joint becomes increasingly painful, swollen and stiff.
“A cheilectomy is a long established procedure for people with moderate hallux rigidus. It involves removing the ridge of arthritic bone (medical term is osteophyte) from the upper surface of the joint. This ridge is often noticed by patients as a ‘lump’ on top of the joint (sometimes called a dorsal bunion) and can cause pain when wearing shoes. The aim is to eliminate pain and increase movement.
“I have a major interest in minimally invasive surgery; in finding safe and effective ways of applying keyhole techniques to established procedures normally undertaken as open surgery. This type of surgery is very amenable to keyhole techniques.
“I start by making a single incision just to one side of the big toe. The incision is the same diameter as a pencil lead (about 3mm) compared with the five centimetre incisions used in open surgery. Through this incision, I am able to create a little pocket over the ridge of arthritic bone. I then remove the ridge, using a high speed burr, which is a thin, narrow surgical drill. The joint is then meticulously flushed out to remove any bone debris. The procedure takes place under x-ray guidance. The incision is so small there is no need for stitches. The patient can walk straight away and can remove all the bandages at 48 hours after surgery (simply leaving a small sticky plaster in place). I normally expect patients to be able to wear their own shoes again by the end of the first week and I encourage them to move the arthritic toe immediately. Most people find that they can return to normal daily activity within a few days of surgery.
“I have completed more than 70 keyhole cheilectomies since I started using minimally-invasive techniques for this procedure two years ago. I have also completed more than 100 minimally-invasive bunion corrections.
“It is clear to me that minimally invasive techniques involve reduced trauma to the foot and to the soft tissues specifically. This means things generally settle down more quickly with less joint stiffness and people are able to return to normal activities more rapidly.”