Understanding First Metatarsal Phalangeal Joint Arthritis and When a Cheilectomy Can Help

Big toe pain can be more than just a nuisance. For many, it signals a condition called arthritis in the first metatarsal phalangeal (MTP) joint. This joint, located where the big toe meets the foot, plays a crucial role in walking, running, and balance. When arthritis affects this joint, it can cause pain, stiffness, and difficulty moving the toe. One surgical option that may help is a procedure called a cheilectomy. This blog explains what first MTP joint arthritis is, how a cheilectomy works, and when this surgery might be the right choice.

First metatarsal phalangeal joint affected by arthritis

What Is First Metatarsal Phalangeal Joint Arthritis?

The first MTP joint connects the first metatarsal bone of the foot to the proximal phalanx of the big toe. This joint allows the toe to bend upward and downward, which is essential for walking and pushing off the ground.

Arthritis in this joint means the cartilage that cushions the bones has worn down. This leads to:

• Pain and tenderness around the joint

• Swelling and inflammation

• Stiffness, especially when moving the toe

• Reduced range of motion

• Bone spurs that can develop around the joint

  
  

This condition is often called hallux rigidus, which means "stiff big toe." It usually develops gradually and can worsen over time.

Causes and Risk Factors

Arthritis in the first MTP joint can result from:

• Wear and tear due to aging or repetitive stress

• Previous injuries such as fractures or sprains

• Genetic factors that affect joint health

• Inflammatory conditions like gout or rheumatoid arthritis

• Foot structure abnormalities such as flat feet or bunions

  
  

People who spend a lot of time on their feet or engage in activities that put pressure on the big toe may be more prone to developing this arthritis.

Symptoms That Suggest You May Have First MTP Joint Arthritis

If you experience any of the following symptoms, it could indicate arthritis in your big toe joint:

• Persistent pain at the base of the big toe, especially during walking or standing

• Difficulty bending or straightening the toe

• Swelling or redness around the joint

• A feeling of grinding or catching when moving the toe

• Development of a bump or bone spur on the top of the joint

  
  

Early diagnosis is important to manage symptoms and prevent further joint damage.

What Is a Cheilectomy?

A cheilectomy is a surgical procedure designed to relieve pain and improve motion in the first MTP joint affected by arthritis. The surgery involves removing bone spurs and part of the damaged bone from the top of the joint. This creates more space for the joint to move freely.

How the Procedure Works

During a cheilectomy:

• The surgeon makes a small incision over the big toe joint.

• Loose bone fragments are carefully removed.

• Damaged or non-viable cartilage is removed, and bone spurs may be smoothed out.

• The joint synovitis is removed to reduce irritation.

• The incision is closed, and the foot is bandaged.

  
  

The goal is to reduce pain and improve toe movement without fusing the joint or replacing it.

Recovery After Cheilectomy

Recovery usually involves:

• Wearing a special shoe or boot to protect the foot

• Keeping weight off the foot for a few days or weeks

• Gradual return to walking and normal activities

• Physical therapy exercises to restore motion and strength

  
  

Most patients notice pain relief and better toe flexibility within a few weeks to months.

When Is a Cheilectomy Recommended?

A cheilectomy is most effective in the early to moderate stages of first MTP joint arthritis. It works best when:

• Bone spurs are the main cause of pain and stiffness

• The joint still has some healthy cartilage left

• The patient has good range of motion but experiences pain during movement

• Conservative treatments like medication, orthotics, or injections have not provided enough relief

  
  

This procedure can delay or prevent the need for more invasive surgeries like joint fusion or replacement.

When Is a Cheilectomy Not the Best Option?

If arthritis has progressed too far, a cheilectomy may not provide enough relief. Signs that it might be too late for this surgery include:

• Severe joint space narrowing or complete loss of cartilage

• Significant deformity or instability of the joint

• Constant, severe pain even at rest

• Limited or no movement in the big toe joint

  
  

In these cases, other surgical options such as arthrodesis (joint fusion) or joint replacement might be recommended.

Other Treatment Options for First MTP Joint Arthritis

Before considering surgery, doctors usually suggest non-surgical treatments:

• Anti-inflammatory medications to reduce pain and swelling

• Custom orthotics to support the foot and reduce pressure on the joint

• Physical therapy to maintain joint mobility and strengthen surrounding muscles

• Activity modification to avoid movements that worsen symptoms

• Corticosteroid injections to reduce inflammation

  
  

If these treatments fail to control symptoms, surgery, such as a cheilectomy may be the next step.

Why You Should See a Specialist for Big Toe Pain

Big toe pain can affect your daily life, making walking and standing uncomfortable. Ignoring symptoms can lead to worsening arthritis and permanent joint damage.

A foot and ankle specialist can:

• Diagnose the cause of your pain accurately

• Recommend the best treatment based on your condition

• Explain surgical options like cheilectomy and what to expect

• Help you recover and return to normal activities

  
  

Early evaluation and treatment can improve outcomes and keep you moving comfortably.