Keller excision arthroplasty aims of surgery

PATIENT INFORMATION SHEET

topic			HALLUX RIGIDUS (ARTHRITIS OF BIG TOE)
Procedure			KELLER EXCISION ARTHROPLASTY
AIMS OF SURGERY		To reduce pain and deformity. To improve the big toe alignment [make straighter]. To improve range of motion
advantages of THIS OPERATION		No need for internal fixation (screws) No bone healing required
SPECIFIC RISKS of THIS OPERATION		Continued joint pain 8% Pain in ball of foot (metatarsalgia) 12.5% Shortening of the big toe, Big toe may not touch the ground / float above the floor		Weakness of the big toe , Malalignment Recurrence

OVERVIEW
Operation time	Usually about 30 minutes
Incision placement / stitches	Usually on top or side of the toe and with absorbable stitches where possible
Procedure	Half of the joint of the big toe is removed by excising the bone at the base of the toe. Any excess bone on the top or side of the joint is removed.
Fixation	This is generally not needed although a temporary wire is sometimes used for stability. This is left sticking out of the toe and requires removal in clinic.
Will I have plaster?	No
Is this a Day Procedure?	Yes, you can usually go home the same day
Estimated time off work	Non-manual work approximately 4-6 weeks
INDICATIONS FOR The procedure	Painful Hallux Rigidus Hallux Valgus where the joint is beyond preservation and the patient is now less active/ mobility is reduced.
ALTERNATIVE TREATMENTS	Manage your symptoms by altering activity levels, using painkillers and anti inflammatories, changing footwear, using an insole or orthotic foot support, joint injection therapy. Other surgical procedures including 1^st MTP joint fusion, joint implant, exostectomy or decompression osteotomy.
GENERAL RISKS OF SURGERY	The general risks of foot surgery are outlined in the Pre-operative Information Booklet which is provided in addition to this leaflet YOU SHOULD READ THIS LEAFLET IN CONJUNCTION WITH THE PREOPERATIVE INFORMATION BOOKLET
MORE INFO By:	1 Speaking with your consultant or one of his team 2 Reading the information provided

KELLER EXCISION ARTHROPLASTY

The operation can be performed comfortably under a Local Anaesthetic block, which is achieved by either a series of injections around the Ankle, or an injection behind your Knee. You will be fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain. If you do not wish to consider having the operation performed whilst still awake, or your Consultant does not feel this is the best option for you, you will be offered Local Anaesthetic with sedation or General Anaesthesia. If this is the case then you may need to be referred to a different surgical team to facilitate this and your consultant will be happy to discuss with you further.

The operation takes about 30 minutes, although you will be in the Day Surgery unit for some time before the surgery and afterwards, to allow you an opportunity to rest post operatively. You must have a competent adult at home for the first day and night after surgery. This allows us to be sure you will be safe for the first night.
First 2-4 days

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  This is the time you are likely to have most pain but you will be given painkillers to help. You must rest completely for 2-4 days.
  
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  You will be able to stand and take weight carefully (using crutches) after the operation, but you must rest, with your feet up, as much as possible.
  
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  You should restrict your walking to going to the bathroom and when getting about use your crutches in the way you will have been shown.
  
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  You can get about a little more after 3 days.
  

One week after surgery

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  You may need to attend for your foot to be checked and re-dressed.
  
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  You may start to do a little more within pain limits. An increase in pain means you are doing too much.
  

Two weeks after surgery

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  Sutures will be removed if necessary.
  
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  You will not need a bandage or crutches any longer.
  
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  You will be asked to start wearing a trainer type shoe.
  

Between 2-8 weeks after surgery

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  If there was a pin inserted, this will be removed during this period.
  
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  The foot starts to return to normal and the majority 87% of patients return to shoes (6-8 weeks)
  
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  The foot will still be quite swollen especially at the end of the day.
  
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  You may return to work but may need longer if you have an active job
  
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  You may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again.
  

Between 8-12 weeks after surgery

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  The foot should continue to improve and begin to feel normal again.
  
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  There will be less swelling.
  
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  Sport can be considered after 3 months depending on your recovery.
  

Six months after surgery

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  You will have a final review between 3- 6 months following surgery.
  
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  The swelling should now be slight and you should be getting the full benefit of surgery.
  

Twelve months after surgery

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  The foot has stopped improving with all healing complete.
  

Please note, if a complication arises, recovery may be delayed

Data information taken from:

1. 
   PASCOM National Audit tool for Podiatric Surgeons. College of Podiatrists
   
2. 
   Kilmartin TE: Metatarsal Osteotomy for Hallux Rigidus. An outcome study of three different osteotomy techniques compared with Keller’s excisional arthroplasty. Br J Podiatry 2000; 3:95-101
   

PATIENT INFORMATION SHEET