Keller’s arthroplasty is a surgical procedure used to relieve pain and improve function in the big toe joint. It is most commonly considered for people with a painful bunion deformity or arthritis of the big toe joint, particularly when the joint has become stiff and difficult to move.
The procedure involves removing a small portion of bone from the base of the big toe. This reduces pressure within the joint and can make walking and wearing shoes more comfortable.
Keller’s arthroplasty is generally best suited for older adults or people with lower activity levels who are more focused on pain relief than preserving full strength and motion in the big toe.
It is less commonly recommended for younger or highly active patients because it can affect toe strength and foot mechanics.
Causes and Symptoms
Two common conditions that may lead to consideration of this procedure are hallux valgus and hallux rigidus.
Hallux valgus is a bunion deformity in which the big toe gradually drifts toward the second toe, creating a prominence along the inside of the foot. Hallux rigidus is arthritis of the big toe joint, which causes cartilage loss, stiffness, and sometimes bone spurs.
Both conditions can cause pain at the base of the big toe, swelling, and difficulty wearing certain shoes. You may notice redness or thickened skin where the joint rubs against footwear. As the condition progresses, walking and pushing off through the big toe can become uncomfortable.
Diagnosis and Evaluation
Your doctor will examine the big toe joint, check how much it moves, and assess the degree of deformity, swelling, and tenderness.
X-rays help show the amount of arthritis, any bone spurs, and changes in the alignment of the big toe. These findings help determine whether Keller’s arthroplasty is appropriate or whether another procedure would provide a better result.
Non-Surgical Treatment
Treatment usually begins with changes that reduce pressure and movement at the big toe joint. Wider shoes, padding over a bunion, and custom orthotics may help improve comfort. Stiff-soled or rocker-bottom shoes can reduce the amount the big toe needs to bend while walking.
Anti-inflammatory medication may help manage pain, and an injection may provide temporary relief in some cases.
If pain continues to interfere with walking or wearing shoes despite these measures, surgery may be considered.
Keller’s Arthroplasty Surgery
During Keller’s arthroplasty, the surgeon makes an incision along the inner side of the big toe joint. If a bunion prominence is present, it may be removed. The surgeon then removes a small portion of the base of the proximal phalanx, the bone closest to the big toe joint.
This creates additional space in the joint, reducing painful contact between the bones. The surrounding soft tissues are adjusted as needed to improve toe alignment. The incision is then closed, and the foot is placed in a protective dressing and postoperative shoe.
Unlike a fusion procedure, Keller’s arthroplasty does not permanently join the bones together. Some movement in the big toe is preserved, although the amount of motion and strength may be reduced.
Recovery After Surgery
After surgery, you will typically wear a postoperative shoe for about four to six weeks. Weight-bearing and walking will be guided by your surgeon, and activity may be limited during the early stages of healing.
Stitches are generally removed around two weeks after surgery. Once the incision has healed sufficiently, gentle range-of-motion exercises may be started to help maintain movement in the toe.
Many patients return to comfortable walking and regular shoes within six to eight weeks. Swelling and stiffness may continue to improve over the following months.
Risks and Possible Complications
As with any surgery, Keller’s arthroplasty has potential risks. These include infection, delayed wound healing, stiffness, and reduced strength in the big toe.
Removing too much bone can cause the toe to become excessively short or sit higher than expected, a position sometimes called a cock-up deformity. Some patients also develop pain under the ball of the foot, known as transfer metatarsalgia, because pressure shifts away from the big toe.
Your surgeon will discuss these risks and whether this procedure is appropriate for your activity level and foot condition.
Long-Term Outlook
Keller’s arthroplasty can provide meaningful pain relief and improve comfort with daily activities, especially in older or less active patients. It is not designed to restore a completely normal joint, and some loss of toe strength or motion should be expected.
The best results depend on choosing the right procedure for the condition and the patient’s activity needs. Other options, such as joint fusion or a different joint-preserving procedure, may be more appropriate for younger or more active individuals.
When to See a Specialist
See a foot and ankle specialist if you have ongoing big toe pain, stiffness, or a bunion deformity that makes walking or wearing shoes difficult despite conservative treatment.
After surgery, contact your doctor if you develop severe or worsening pain, increasing redness, significant swelling, drainage, or fever, as these may indicate a complication.
Insurance and Cost
Keller’s arthroplasty at Complete Orthopedics is covered by Medicare and most major commercial insurance carriers, including Aetna, Anthem BCBS, Cigna, Empire BCBS, and UnitedHealthcare, as well as most workers’ compensation and no-fault insurance carriers. Your out-of-pocket cost depends on your specific plan, deductible, and medical necessity requirements.
Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss expected out-of-pocket costs.
For a full list of accepted insurance plans, visit our Insurance Information page.
The content on this page has been authored, edited, or approved by the doctors below, and was last reviewed for accuracy on November 12, 2026.
