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Cheilectomy Recovery

Discussion in 'Ask your questions here' started by JPworcester, Oct 30, 2009.

  1. JPworcester

    JPworcester New Member

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    Hi, I'm a 28 year old male who had a cheilectomy with subchonral drilling (had bad arthritis) and gastroc recession about 4-5 weeks ago. I had hallux limitus probably due to super flat feet. The recovery has been going well, maybe not as fast as i want :). I was out of the boot maybe 2-3 weeks post-op. My doctor mainly wanted me in the boot longer because of the heel chord, not the toe.

    My question is about the pain in the MTP joint post op. I mean i can manually move the toe up almost 90 degrees now, but not even close to normal pushing the toe down. It seems like the vast majority of the pain is from the TENDON on top of my toe. it seems extremely tight and sore and I'm wondering if this is normal? Does this recovery take much longer than I thought? Also, moving the toe without my hand is quite challenging. seems like the progress has plateaued a bit.

  2. FootDoc

    FootDoc New Member

    A cheilectomy is generally an inadequate procedure for BAD osteoarthritis of the great toe joint, so, if you have had that procedure and now have 90 degrees of dorsiflexion, I wonder if you really have BAD the arthritis which you stated. 90 degrees is excellent dorsiflexion and certainly sufficient for a normal gait. The amount of plantarflexion of the great toe joint is irrelevant, as the only use of the flexors in ambulation is to stabilize the great toe and give it purchase power while in dorsiflexion. The toe never actually plantarflexes below the weight bearing surface other than when walking on sand. As long as your great toe rests on the weight-bearing surface when bearing weight but at rest, it should be okay. If you are able to dorsiflex the great toe 90 degrees, other than some pain from the surgery itself, I don't know where it might be coming from. I can't tell you if recovery takes longer than you had anticipated, as I don't know how long you thought it was going to take, but active and passive dorsi and plantarflexion of the great toe WHEN AND AS ADVISED BY YOUR DOCTOR is generally required physical therapy after the procedure. Timing is of the essence in rehabbing the joint.
  3. JPworcester

    JPworcester New Member

    I can wear sneakers + orthotics without much discomfort. The pain is mostly in the morning/evening when the toe is stiff. I start PT on Tuesday, about 5 weeks post-op. as my doctor has instructed, i have been moving the toe up and down regularly. after i work it a bit i can get it to 80-90 degrees dorsiflexion. the pain isn't really from moving the toe, but more of the tendon connected to the toe. maybe its from the surgery as you mention. it seems like the recovery time varies from individual to individual.

  4. Sarah O

    Sarah O New Member

    You can get damage to tendons or nerves from surgery (I did) but more often than not the tendon needs help to get going after a long period of immobility through surgery and from before if you were limiting your activities. I found massaging the top and bottom of foot post my 4 surgeries helped get rid of this tendonitis. Getting proper physio with intrinsic exercises really helped. Don't under-estimate how long recovery takes and be assiduous with your exercises. Make sure you listen to the doc and don't push before you are ready. Good luck.
  5. Unregistered

    Unregistered Guest

    Thanks for the reply. I'm now over 1 year post-op and I agree, don't underestimate the recovery time. I would say I was maybe 90% better within a few months. It's definitely worth the surgery in the sense, that I can now wear most shoes without becoming crippled :). I still have some discomfort on and off especially since winter came. My foot is much better when I stay on top of stretching my heal chord and doing trigger point massages on the calf and achilles area and of course wear orthotics. I felt really good towards the end of summer into fall, and then the blessed winter came and it felt like I was back to how I was a few months after the surgery. So I guess cold weather, especially during storms doesn't go well with joint surgery. In a nutshell, there are times where it feels 100% and then there are times where I have discomfort. For me I think it also has to do with getting a lot of cartilage removed. When I'm tight, I'm sure there is some bone on bone contact. Anyways, I'm looking forward to the weather getting better and trying to run a bit.
  6. Runningguy

    Runningguy Guest

    I'm a rather active 50 year old male and have hallux rigidus in both feet.
    The hallux rigidus that I developed came from many years of running. I had my first cheilectomy op on my right foot in 1997. That seems soooo long ago that I vaguely remember what recovery was like, but I can tell you that I went on to run almost every day for years, run 5 marathons and backpack many hundreds of kilometers.
    The right toe knuckle has since regained the osteophytes that were removed, and the cartlidge is almost completely gone...but the pain is minimal and sporadic...certainly tolerable. No surgeon wants to attempt another clean up of that joint, and my only option for that toe is fusion.
    No way to the fusion option!!!...I'll take whatever pain I have...and wait for joint replacement technology to advance in the hopes of one day taking advantage of that.

    I'm between 8 and 9 weeks post op from cheilectomy surgery of my left toe. Pain only occurs when I walk.
    Was on Oxy for about a week and a half after surgery, then switched to ibuprophen and acetaminophen for pain management.
    I can handle the pain (I've been doing so for the past few years anyway...like I'm sure most of you have as well...) but what most concerns me is the ability to put weight on the toe AND the lack of strength.
    I've been doing the excersises advised by the surgeon, including toe raises, ankle strengthening, massage over the scar (once it healed) and forcing the toe to the extremes of it's range (last reported at 45 degrees max by a physio therapist).
    After my 2 week post op checkup, the surgeon said I can do anything I want, just ease into it.
    Well, I started by riding the bike, then using the elliptical trainer (forward and backwards), and 3 weeks ago started running again. Tested it on the treadmill first. Pain for sure, but I was able to do it...so I gradually increased my distance and ran once every 3 days or so (cycling in between). I just ran a 10k and, using pain as my guide, was in no more pain at the end of the run than I was when I started.
    The issue of lack of strength in the toe means that my running form is off...and I'm running a lot slower than I was.

    Just had my 2nd post op appointment, and the surgeon says that I'm coming along well...when asked how long will it be before I get back to any semblance of "normal", he said two things;
    1; that joint will never be as good as it was before it became arthritic
    2; it's only been 8 weeks since the surgery...

    My question is; how long did anyone who has had this surgery have to wait (doing excersizes of course...) until they re-gained the strength in their toe?

    Last edited: Mar 6, 2011
  7. Pirotta

    Pirotta Guest

    I'm three weeks post cheilectomy on my left foot and still in the "boot". Only take it off for showers and sleep and am very worried how I'll be when it comes off for good in another week because I seem to fall forward.....my balance has been affected. Also, I have pain stretching my toe in order to get full range of movement. Maybe it's the tendons, not the bones. I have to start physio soon.....what is entailed? If anyone can tell me I'd appreciate it.
  8. Unregistered

    Unregistered Guest

    I had my cheilectomy 4 months ago and I should have it done on my other foot too. But I would never repeat this surgery. The healing has been so slow, and it seems I traded one pain for a more intolerable one. My gait has changed, there is sharp, stabbing pain with each step. Physical therapy has given me a tad more mobility but has not helped with the pain. If I had to do it all over again, I wouldn't. Good luck to anyone facing this procedure. I'm looking into holistic, natural ways to help the other foot instead.
  9. Bosey

    Bosey Guest

    Seven Days Post

    I'm seven days post op and my doctor had told me I'd be cursing his name when the nerve block wore off mid week last week. what I feel is no more pain than I had before the surgery, so I'd say I'm doing well. The toe hurt 24/7 anyway, so I'm hoping this will relieve any amount of the pain, which again, hurts no worse than before Doc sliced into my foot. Not sure how much time off work this will require and no talk of PT for another two weeks, any one have any idea of healing time and comfortable back to work for a desk job?
  10. Unregistered

    Unregistered Guest

    Sounds like a question that should best be asked to whoever you trusted to do the surgery and knows you.
  11. Unregistered

    Unregistered Guest

    4 weeks post-op, and I ran my first 5K on a treadmill. Easy recovery. Much easier than living with the pain of hallux rigidus. That burning has left my body, never to return. The surgeon was great, and honest with the expectations. As long as you don't expect to ever have a perfect joint, all will be well. My only expectation was the be pain free, and I'm certain I will achieve that. The pain from the surgery lessens every day. I'm 56, and on track to run a marathon this fall. That was the whole point of the surgery. Either I had to quit running, or do the surgery and get another 10-15 years out of the joint. I opted for the surgery. Happy I did. Do your homework, pick a great surgeon who has done it a million times, and really work through the recovery. You'll be happy you did.
  12. Unregistered

    Unregistered Guest

    The questioner already had the surgery and was asking about recovery time. It's kinda late to give him advice about picking a surgeon, don't you think?
  13. Unregistered

    Unregistered Guest

    As mentioned, I was recovered nicely in 4 weeks. You'd be surprised how many of us thinking about the surgery scour the internet looking at these kinds of forums for information to help us make an intelligent decision. Obviously, each person is different, and can have a different expectation with respect to recovery time. I can only speak for my own recovery.
  14. Unregistered

    Unregistered Guest

    That's unfortunate, since unless the comment comes from an experienced professional who has enough information to offer one, the information is not likely to be something that a patient should rely enough on for real consideration in making an important decision. That's why you pay to go to a doctor who had done it before and whose business it is to really known the answers. Patients only have their one experience. They don't know if it's typical or whether they had the proper care even if it happened to succeed or poor care if it happened to fail.
    Last edited: May 15, 2011
  15. Unregistered

    Unregistered Guest

    I live in Orange county. Do you recommend a surgeon I could go see for my right big toe pain? I'm nervous about surgery. I am a runner as well.
  16. Unregistered

    Unregistered Guest

    Had the surgery on May 26th it is now June 9th. Still a little pain but a lot better. Have not had a pain pill in weeks. Not as bad as i thought. Gait is still a little off.
  17. Unregistered

    Unregistered Guest

    I had cheilectomy 13 days ago, first couple of days were really really painful and I had to walk with crutches but by day 3 I was managing the pain and able to begin weight bearing very very carefully. Had the dressing and stiches removed on day 11 - now at day 13 and still limping badly and not able yet to get ordinary shoes on but am managing the pain easily. I am a 50 year old female who had the op to give me some flexibility back in my joint due to arthrits.
  18. houtx

    houtx Guest

    I had both feet done yesterday and am hoping it will all be worth it...when I read the posts it looks hit or miss. I am a 49 year old physically active female and the pain had gotten frequent enough and limiting enough that I decided to go ahead and bite the bullet. I have great confidence in my surgeon and he says my pain should be 90% reduced and not to expect full range of motion in the toes but I will regain some. At surgery he was able to get 85% range of motion and he told me prior to surgery that when it is all said and done I should be able to retain about 50% ROM with little to no pain. I'll take that even if it takes a while but I hope it doesn't take 12 months as some posters here say it can take...

    Currently I am keeping my legs elevated on 3 large (fat) pillows and icing with frozen peas (but can't feel the coolness through the bandages so I'm wondering if this is helping?? I don't have too much pain lying in bed but can't bear weight on the full foot when I get up..After a few steps it does get better though...and is much better with the beautiful Frankenstein shoes they provided. Tomorrow I go back for dressing change and will find out a little more about when I should begin ROM exercises (immediately or after stitches are removed??) Still taking Norco for pain but have moved from every 4 hours to every 6 hours so hopefully tomorrow I will be able to back off more...What I am really wondering is when will I feel like I can be more mobile without feeling like I am walking like a goon?? Any feedback is welcome and I will post again tomorrow if anyone is interested in hearing what doctor says tomorrow.
  19. Unregistered

    Unregistered Guest

    Please think very carefully about getting this surgery. I am now 2 weeks post op and am wondering if I will ever walk properly again and I am only 33. I had this surgery in Spain and due to language barriers didnt ask the surgeon the questions I wanted to know. I have to go back to work next week but doubt this will ever happen. Unless you seriously cannot move or have extreme pain DO NOT have this surgery. I bitterly regret having it done.

    Also, I have been told nothing about exercises or physical therapy (well I do live in the most backwards country in Europe) and have no idea if I should be doing anything. I can barely move my toes and it hurts when I try.
    Last edited: Aug 24, 2011
  20. jbk51691

    jbk51691 Guest

    I had pain above the big toe joint after whacking my toe into a piece of furniture. Three months later and an xray showed that I broke a bone spur on the big toe joint and it needed to be removed. Doctor got into the joint and removed the broken bone spur, filed down what was left of the existing bone spur and cleaned out the cartilage that was barely hanging on. He drilled some holes into the bone to increase the cartilage to regrow. This was the recovery process.
    Week 1 post-op- no weight bearing at all. Continual elevation. Wore a surgical boot and rode around on a kneeler cart or used my crutches. Elevation is key this first week to get the swelling down and begin the healing process faster. Do it!!
    Week 2 post-op- moved out of a surgical boot and into a walking boot. Transitioning for 1 week into full weight bearing with boot to 100% walking with boot and no crutches. PT therapy begun
    Week 3 post-op-full week of walking boot, 2x week PT
    Week 4 post-op- transitioning to no boot. 1-2hrs/day, 2-3, 3-4 hrs out of boot till over 8rs out of boot. 2x PT
    Week 5 post-op- no boot, no crutches, regular shoe. 2x PT, Treadmill walking on Alter G treadmill at 30% body weight.
    Week 6 post-op- begin running on Alter G treadmill with only 30% body weight. 2x PT
    Week 7 post-op- took a rest from treadmill and PT as toe was starting to hurt to the point it was becoming uncomfortable to walk. May have done too much the week before. Toe already starting to feel better from rest. Still walking around etc.
    Week 8 post-op Begin treadmill walking alternating with interval running on Alter G treadmill.

    I will be beginning week 8 and although I still cannot run I am happy to be moving around. Key things for recovery is PT, PT, PT!!!! PT know what exercises you need to be doing and they give you the confidence to touch the scar area and help answer questions for you. PT in the past has never been helpful for me as a runner except this time.

    I am hoping to start back on the Anti Gravity treadmill next week and will gradually work back into running.

    The hardest recovery on the toe has been the pointing the toe downward as opposed to upward. According to PT that is normal and as recovery progresses range of motion will return but exercises are critical and massaging of scar area.

    When I was wearing the various boots for 4 weeks I would several times during the day I would remove the boot and move my ankle around and stretch it out. Wearing a boot can cause more problems so I didnt want my ankles getting stiff or having achilles problems. First week of post op I had to sleep with a surgical boot and thats not easy but during elevation or rest I would remove the boot and allow the foot to be "normal". I think this helped in the PT process as I am doing well on the ankle exercises.

    My goal is to be running in 12 weeks. Doctor says he doesnt recommend pavement running till 3months so I am on target with that but will still continue to be on the treadmill. I have a 5k resolution run scheduled on Week 18 and I plan to be in that running or walking!!

    Hope this has been helpful for people as I searched alot for answers and couldnt find much. Its always helpful to hear what others go thru. Everyone is different and how they tolerate pain etc. I used the vicodin for the first week and then stopped using it and havent needed anything for pain that rest couldnt fix. I also used Phiten tape on the scar area and Kinesio tape to help support the area when I started using it more.

    Every week my flexibility in the joint gets better so just be patient and it will come. I am a runner and know what it feels like to want to get back to running. I started back too soon and paid the price. I will now make sure I ease back into it. Cycling is also a good non weight bearing activity and I have been doing alot of weights in the gym as well. Mainly arm weights. Good luck
    Last edited: Oct 21, 2011

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