A cheilectomy is a surgical procedure performed on the great toe joint, typically to remove bony spurs (osteophytes) that form due to arthritis, a condition known as hallux rigidus. This procedure is intended to reduce pain and improve the toe’s range of motion. Proper foot elevation is the most important factor in the initial recovery period, directly influencing pain levels, wound healing, and the overall timeline for returning to regular activity.
The Critical Duration of Foot Elevation
The required duration of foot elevation after a cheilectomy is understood in two distinct phases, beginning with a period of near-constant, strict elevation. For the first 48 to 72 hours following surgery, the foot should be elevated almost constantly, with the exception of brief periods for necessary movements like using the restroom. This rigorous schedule prevents fluid accumulation in the surgical site, which causes painful throbbing and increased pressure on the incision. Using gravity promotes venous return, allowing blood and excess fluid to drain from the foot.
Following this initial intensive phase, the requirement shifts to a modified but diligent elevation schedule for the next one to two weeks. The foot should be elevated whenever you are sitting or resting, aiming for 60% to 70% of the day. This continued practice is necessary because the inflammatory response persists, and failure to elevate causes swelling to quickly return, which can compromise the healing of the soft tissues and skin incision. Maintaining a low-pressure environment at the surgical site allows for optimal cellular repair.
Proper Techniques for Reducing Post-Surgical Swelling
Effective elevation requires positioning the foot higher than the heart, often described as “toes above the nose” when lying down. This height ensures gravity is fully utilized to encourage fluid drainage. When lying down, using two or three pillows or a specialized wedge under the calf and heel achieves the necessary angle without putting pressure on the knee. Sitting in a recliner where the foot is lower than the heart is not considered proper elevation and will likely result in increased swelling and pain.
Integrating cold therapy with elevation maximizes the anti-inflammatory effect during the first few days of recovery. An ice pack should be applied to the surgical dressing for about 20 minutes, followed by a 20-minute break, repeating this cycle multiple times daily. Avoid placing ice directly onto the skin or an uncovered incision, as this can cause tissue damage or frostbite. A sudden, intense throbbing or sharp pain when the foot is lowered indicates that the previous period of elevation was insufficient.
Progression to Weight-Bearing and Normal Activity
Once the period of strict elevation is complete, the focus shifts toward a gradual transition back to functional use of the foot. Many cheilectomy procedures allow for immediate weight-bearing in a protective surgical shoe, often limited to the heel area for the first one to two weeks. This specialized shoe, which has a rigid sole, is worn at all times when walking to protect the healing joint and incision. Crutches or a walker may be used initially to ensure stability and limit the total amount of weight applied to the foot.
The transition from the surgical shoe to normal footwear is typically initiated around two to four weeks post-operation, depending on swelling and pain levels. Patients are advised to first use a wide, supportive shoe, like a trainer, that can accommodate any residual swelling. After the initial two-week period, gentle range-of-motion exercises for the big toe are introduced to prevent joint stiffness. Formal physical therapy may be prescribed to ensure the return of full mobility, with a return to pre-surgery activities generally occurring between three to six months.