Minimally Invasive Stiff Big Toe Surgery Introduction

The London Foot and Ankle Centre was the first in London to introduce minimally invasive techniques and now has six years of experience in minimally invasive big toe surgery, known medically as the cheilectomy.

This section explains more about the cause of a stiff big toe (hallux rigidus) and how it can be treated using minimally invasive techniques.

Who needs MIS for Stiff Big Toe?

What is a stiff big toe (hallux rigidus) and why does it develop?

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.

How does it work?

Surgery for a stiff big toe

The established surgery for people with a moderate degree of hallux rigidus is called a cheilectomy. 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.

Minimally invasive surgery for stiff big toe (cheilectomy)

LFAC is recognised as being the leader in the UK for establishing minimally invasive surgery in the foot and in finding safe and effective ways of applying keyhole techniques to established procedures normally undertaken as open surgery. The cheilectomy is very amenable to keyhole techniques.

The surgeon starts 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, the surgeon is able to create a little pocket over the ridge of arthritic bone. Then, the ridge is removed, 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.

What sort of experience do you have of this type of surgery?

David Redfern, the LFAC surgeon who first introduced minimally invasive surgery in London, has completed many hundreds of keyhole cheilectomies since his first procedure of this kind undertaken four years ago. Combining minimally invasive techniques with established surgical procedures, Mr Redfern has also completed more than hundreds of minimally-invasive bunion corrections. Nationally and internationally recognised for his expertise in this field, Mr Redfern recently presented and led training on minimally invasive techniques for the European Foot and Ankle Society.

“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.”

Mr David Redfern, Consultant Orthopaedic Surgeon, LFAC

How long will it take to recover?

What sort of recovery can I expect after minimally invasive big toe surgery?

The patient can walk straight away and can remove all the bandages at 24 hours after surgery (simply leaving a small sticky plaster in place). Patients are normally able to wear their own shoes again three to four days after surgery and are encouraged to move the arthritic toe immediately. Most people find that they can return to normal daily activity within a few days of surgery.

“Having had an open cheilectomy 15 years ago on one toe and a minimally invasive cheilectomy recently on the other toe, I wish I could have had minimally invasive surgery on both toes. The results are marvellous.”

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