A Keller’s arthroplasty is a surgical procedure to remove bone from the spot where your big toe joint meets the metatarsal bone and replace it with soft tissue.
This procedure is often done when your toe joint is affected by bunions or hallux rigidus (aka stiff big toe), which can cause pain and swelling in your toe. A Keller’s arthroplasty can help relieve long-term foot pain and help you use your foot more freely.
Read on to learn when a Keller’s arthroplasty is done, what risks and complications to keep in mind, and what results you can realistically expect from the procedure.
A Keller’s arthroplasty may be recommended if you have severe forms of conditions that cause pain or lack of movement in the joint at the base of your toe, such as:
- Hallux limitus: If you have hallux limitus, the joint is swollen and stiff.
- Hallux rigidus: If you have hallux rigidus, the joint is swollen, painful, and almost impossible to move.
- Hallux valgus: This condition is more commonly known as a bunion. It happens when your big toe pushes against the toe next to it and the joint becomes bent, resulting in a bump on the side of the big toe joint.
A Keller’s arthroplasty is usually done if you’re over age 55. It’s not recommended for younger people because while it relieves the stress on the big toe, it causes new pressure on other bones in the foot.
A 2020 study looked at the results of Keller’s arthroplasty procedures received by 28 different people over a 22-year period. The study compared this procedure with two other common treatments for hallux rigidus: cheilectomy and arthrodesis.
Researchers found that Keller’s arthroplasty was usually more successful at stopping the long-term effects of hallux rigidus than cheilectomy — but that the overall outlook was better with arthrodesis.
Possible risks and complications of Keller’s arthroplasty include:
- blood clots (deep vein thrombosis)
- nerve damage
- permanent loss of motion in your toe
- chronic foot pain (complex regional pain syndrome)
- a return of bunions if the cause isn’t resolved
- a shortened toe from too much bone removal
- structural changes in the toe, such as the toe sticking up awkwardly (cocked-up hallux)
A Keller’s arthroplasty is usually performed at a hospital by a surgeon.
You can usually go home the same day as a minor procedure. But you may need to stay for 1 or 2 days if the surgery is extensive.
Before the procedure
Follow any instructions the surgeon gives you, including:
- getting blood tests or imaging tests, such as X-rays
- quitting smoking if you smoke (this can be difficult, but your doctor can help create a cessation plan that works for you)
- stopping blood thinners, if you currently take any
- fasting up to 12 hours before surgery
If you can, take some time off work or other activities that require you to move around regularly.
Set up your living space so that you don’t need to move around a lot to take care of basic tasks, such as making food or using the bathroom. If possible, ask a friend or family member to help you out while you recover.
You may also want to ask someone to drive you to and from the procedure.
During the procedure
Here’s how a Keller’s arthroplasty is done:
- You’re put to sleep using general anesthesia.
- The surgeon opens a small cut near your big toe joint.
- They’ll take out a part of your bone near the joint.
- They’ll replace the bone with new tissue to create a joint-like structure.
- They’ll insert a pin to keep the joint from moving too much while it heals.
- They’ll close the cut with stitches or sutures.
After the procedure
You’ll be brought to a recovery room and gradually wake up as the anesthesia wears off. Your care team will monitor your vital signs, such as your heart rate and breathing, to make sure you’re not experiencing any significant complications from surgery or anesthesia.
Your care team may also clean the surgical area, then dress it to keep it dry and clean. Once your vital signs are stable, the surgeon will visit you again and give you instructions for the next few weeks. You may set up some post-operative appointments to re-dress the surgical area and check on your healing.
Right after the procedure, you’ll wear a surgical boot and likely need to use crutches for about 2 weeks. Follow the surgeon’s instructions for taking pain medication for the first few days.
Keep your foot elevated to prevent blood from swelling in the area. Try a cold compress to relieve pain and swelling.
Stay off your foot for a few days after surgery. Do not put your full weight on your foot until the surgeon tells you it’s OK to do so.
Do not bathe, shower, or swim while your foot dressings are on. Replace your dressings as needed.
You’ll usually get stitches removed within 1 or 2 weeks. You’ll then need to get an X-ray about a month after the procedure so that the surgeon can assess how your joint has healed. If it is healing well, the surgeon can remove any pins.
The surgeon will likely recommend certain kinds of shoes you can wear that won’t put pressure on the joint. You may need to wait another 2 to 4 weeks until you can wear regular shoes or resume your daily activities again.
Keller’s arthroplasty recovery time
Your recovery time depends on how extensive the procedure is and how well you take care of your foot after the procedure.
Typically, you’ll fully recover from a Keller’s arthroplasty procedure within 6 to 10 weeks after the surgery.
Keller’s arthroplasty isn’t always recommended for big toe pain and stiffness, especially if it’s caused by lifestyle choices or if you’re under 55 years old.
Here are some alternatives to Keller’s arthroplasty that a surgeon may suggest:
- wearing different shoes to reduce pressure on your big toe when you walk
- relieving toe pain with nonsteroidal anti-inflammatory drugs
- getting corticosteroid injections to relieve pain and swelling
- cheilectomy to remove bone spurs
- arthrodesis to fuse toe bones together and reduce pain caused by joint motion
Keller’s arthroplasty is a common and often successful procedure to treat long-term pain and stiffness in your big toe. It’s done when pain can’t be treated by pain medications or lifestyle changes.
Complications are rare. Get immediate medical help if your toe isn’t getting any better after surgery or if notice any symptoms of infections, such as thick discharge or intense pain.