Keller X-ray
Hallux rigidus
Hallux rigidus
Severe arthritis of the big toe
Bunions and big toe joint arthritis

Frequently asked questions

When is the Keller procedure indicated?

The Keller procedure is a well established approach to treating big toe joints with severe arthrtic change. The operation is not sutable for patients where there is a possibility of preserving the joint by alternative methods.

How is the Keller operation performed?

The Keller operation is performed through a small cut over the top of the big toe joint just to the inside. Any damaged areas of bone are removed or smoothed. Usually the bump on the side of the big toejoint is removed. The "Keller" part of the operation involves removing a section of the big toe bone. What is important is ensuring the fibrous layer around the joint (joint capsule) is properly relocated inside this new space. Mr Metcalfe has performed many hundreds of these procedures and the technique of "capsular inter-posiiton" improves the clinical results.

What are the benefits of the Keller procedure?

Historically this operation has been the subject of much criticism but this is largely due to either the operation being performed in the wrong circumstances or due to poor technique. When correctly indicated and performed well by the surgeon this can provide excellent pain relief and still allow some passive movement in the big toe joint. The operation does not require the insertion of any pins or screws and once the skin is healed in about 2 weeks patients are free to begin a return back to normal activity.

What are the downsides of the Keller procedure?

Like all surgeries there are pros and cons to each and every operation. The Keller will give rise to some shortening of the big toe. This also true of the big toe joint fusion. There are also some reports of transfer metatarsalgia being more common compared with big toe joint fusion. However the Keller procedure has less risk of operative complications and provides a much speedier recovery compared with fusion of the big toe joint. The most important thing to do is have your foot carefully assessed clinically and with x-rays. Mr Metcalfe will explain which treatment options are best suited to you on an individual basis.