Hallux Rigidus (Open Cheilectomy)

Preparation for Surgery

You should have received a letter detailing the codes and costs for the surgery and giving instructions on where to go and at what time. Please check these details carefully as you will be liable for any costs not covered by your insurers.

You will need to be nil-by-mouth – No food for 6 hours before surgery. Clear fluids can be taken for up to 2 hours before the operation.

MRSA status

Before or on admission to hospital a nasal swab will be taken to screen for MRSA. There is a small chance this is positive. If so your operation will be moved to the end of the list or rarely to another day to prevent cross infection.

Anaesthetic

The surgery is normally a daycase procedure, performed under a general anaesthetic with local anaesthetic after for additional pain relief. It is not normally a particularly painful operation and most patients report minimal pain.

Risks of surgery

Swelling & Stiffness

Initially the foot will be very swollen and needs elevating. It will be stiff in the immediate post-operative period but movement should return rapidly (2-4 weeks). The movement should improve with surgery, but this is not always the case. The swelling will disperse over the following weeks but will still be apparent at 6 months.

Infection

There is always a risk of infection with surgery. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for 7 days. If there is an infection, it normally resolves with a course of oral antibiotics.

Continued Pain

The symptoms in this toe are due to either biomechanical abnormality in the joint (not arthritis) or they may be the first signs of arthritis in the toe. The aim of the surgery is to improve the movement in the joint and relieve pain. Overall the results from surgery are excellent.

However, if the joint has some arthritis, this may be exacerbated by the surgery and cause continued or increased pain. It is not always possible to tell prior to surgery, whether this is the case.

If there is symptomatic arthritis in this joint later, then a further operation will be necessary.

Immediately after surgery

Following surgery, the toe is protected in a specialised dressing and postoperative shoe. The dressing can be reduced to a simple elastoplast at 3 days.

You will be seen by a physiotherapist on the ward, who will advise on walking and early rehabilitation. You will be allowed home only when you are comfortable and capable.

Recovery from surgery

Following surgery, the toe is protected in a specialised dressing and postoperative shoe. The dressing can be reduced to a simple elastoplast at 3 days.

Elevation of the foot (above the pelvis) for the first 7 days is vitally important to prevent infection. Naturally, small periods of walking and standing are necessary.

This type of operation and the postoperative shoe allow weight bearing (walking) immediately. The postoperative shoe can be discarded once the dressings have been reduced. If ordinary footwear is still uncomfortable then a hard soled sandal is often a good idea. The swelling may take 1-2 weeks (rarely longer) to settle enough to wear normal shoes.

Driving is allowed after 3 days, only if normal shoes are worn.

Exercise and sport can start after 2-3 weeks, but will take 2 months to become comfortable.

Swelling - many patients worry about the swelling. It is a natural response to the surgery and will take a few months to go.

Physiotherapy: This can be started after 7 days.

Pain relief and take home medications

You will be given high doses of prescription painkillers to take home. Use these for the first 2-3 days and reassess.

Weight-bearing

You can walk on the foot immediately, in the protective shoe - the physiotherapist will assess and help you.

Washing and Bathing

It’s important to keep the dressing completely dry – the nurses will show you how to do this with a waterproof cover.

Activity and time off work

In general, up to 2 weeks off work is required, possibly more if your job involves a lot of physical activity such as walking and standing.

When can I start to drive again?

The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. Driving should be possible after 7 days, but only if normal shoes are worn.

It remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

Results of surgery

The short to mid-term results of this type of surgery are very good and the majority of patients get excellent relief for many years. It may be better to consider this as an interim procedure, as the underlying arthritis will continue to affect the joint and so symptoms can often recur after several years.