Keller’s arthroplasty operation: A guide for patients

A Keller’s arthroplasty removes the base of the bone from the big toe. The procedure is used to manage a bunion deformity and stiff big toe joint.

The procedure is used in the management of both severe osteoarthritis as well as bunion deformity. However, the procedure has very specific indications and would not be suitable for all patients. Following this procedure, the big toe will be shorter and can be become less stable (floppy).

Treatment options

Treatment options consist of both conservative and surgical pathways.

Non-surgical treatments

• Joint padding and protective shields
• Gel/silicone wedges between the toes
• Avoid high heeled shoes
• Surgical footwear
• Cortisone (steroid) injections
• Insoles (orthoses).

Surgical treatment

If the big toe joint is stiff and arthritic, removing the base of the bone stops the degenerative cartilage rubbing against one another and removes the painful stimulus.

In a bunion deformity, removing the base of the bone relaxes the soft tissue and, over time, leads to a reduction in the size of the deformity. At the same time, the bump on the side of the joint is also removed, which reduces irritation from footwear. This is known as Silver’s procedure.

About day case surgery under local anaesthetic

The Keller’s arthroplasty allows for a quick recovery as it does not involve any bony healing. There is no need for screws or plates to be used, so once the stitches are removed you can to return to a lace-up pair of shoes and your normal activities.

Surgery is carried out under local anaesthetic as a day case. This means that you are awake during the operation, but a screen will prevent you from seeing the surgery.

To numb your foot, you will either be given some injections around your ankle or behind the back of the knee.

You can eat and drink on the day of surgery; there is no need for fasting.

The operation may take up to 40 minutes, but you should be ready to be at the hospital longer than this to allow for preparation and recovery.

Throughout the operation you may have a tight band around the ankle to keep the blood away from your foot. This is sometimes uncomfortable but is immediately released after the operation.

If you decide on surgery you will be invited back to attend a pre-surgical clinic. A member of the nursing team will take your medical history. If you are on any medication, please bring a list with you. This is a good opportunity to ask us any questions and discuss any concerns you may have.

You must have a competent adult at home for the first day and night after surgery.

Post-operative recovery

The first two to three days

• You must rest with your foot elevated to hip level.
• You should restrict your walking to bathroom visits only. If you have been given crutches, you must use them in the way shown. You may be able to bear a little weight on the foot.
• If you experience pain, you should take the prescribed painkillers. It is usually worse for the first two days.
• If you are still experiencing pain after three to four days that is not relieved by the painkillers, you should contact the department directly.
• If you have any concerns over your foot, you should contact the department directly
• The department is closed at weekends. Out-of-hours, you should contact your GP or go to your local accident and emergency department.

Two weeks after surgery

• Two weeks after the operation you must come back to us for the dressing to be removed.
• By this time, the skin should be healing well and any non-dissolvable stitches will be removed.
• You should no longer need a bandage and should be able to wear a normal shoe again. The shoe does need to be roomy, for example a running trainer, because your foot will be quite swollen. If you do not have any, you will need to buy some before the surgery. You do not need to spend a lot of money on this shoe.
• One to two days after the stitches have been removed you can normally start bathing the foot.
• At this stage you can gradually and gently increase your activities. You will still need to rest between your activities.

Between two and eight weeks after surgery

• The foot starts to return to normal. The majority of patients can return to their normal shoes.
• The foot will still be quite swollen, especially at the end of the day.
• You may return to work but may need longer if you have an active job.
• You may return to driving if you can perform an emergency stop. You must check with your insurance company before you start driving again.
• While normal activity can be resumed, sport should be avoided.

Between eight and 12 weeks after surgery

• The foot should continue to improve and begin to feel normal again.
• There will be less swelling.
• You can return to sporting activities at 12 weeks.

Six months after surgery

• The swelling should now be slight and you should be getting the full benefit of surgery.

Twelve months after surgery

• The foot has stopped improving with all healing complete.

Frequent or serious occurring risks

All carry a small risk of complications. In foot surgery, complications are uncommon and most are resolved without permanent disability or pain.

General and specific complications of this procedure include:

• infection (two in 100)
• delayed healing of the skin (eight in 100)
• non-compliance of patients (four in 100)
• continued joint pain (eight in 100)
• pain in ball of foot (metatarsalgia) (13 in 100)
• weakness of the great toe
• great toe may float above the floor
• insufficient correction
• recurrence of deformity
• hallux varus (the big toe deviates towards the other foot)
• blood clot deep vein thrombosis (DVT).

Complications following foot surgery are rare but can happen. It is important to remember that if there is a complication you will need to visit the hospital more frequently and there could be a significant impact on your recovery and return to work time. Foot surgery should be avoided if only for cosmetic gains.