First MTP Joint Resection Arthroplasty (Keller Procedure)

​What is a first MTP joint resection arthroplasty? 

A first metatarsophalangeal (MTP) joint resection arthroplasty treats arthritis of the big toe. This procedure stops pain by

X-rays showing a normal first MTP joint (above) and arthritis in a first MTP joint (below).

preventing the surfaces of the big joint of the big toe from rubbing together.

What are the goals of a first MTP joint resection arthroplasty?

The primary goal is to lessen pain.

What signs indicate surgery may be needed?

First MTP joint resection arthroplasty is used to treat severe first MTP joint arthritis. The main symptoms are pain and loss of motion at the joint between the big toe and the foot. Your orthopedic foot and ankle specialist will examine you and take X-rays to determine the extent of your arthritis.

When should I avoid surgery?

Patients with infection or blood vessel disease should not be considered for the surgery. Young age and poor skin around the joint or large deformity are sometimes barriers to surgery. Diabetics should consult their doctor before this surgery.

General Details of the Procedure

An incision is made over the first MTP joint and carried down to the joint. The joint capsule is then opened to expose the diseased joint. The joint surfaces along with a small amount of bone are removed from the arthritic joint, which creates a space (see post-surgery X-ray). Tissues around the area are then sewn together to stabilize the space. Finally the joint capsule and skin are closed with stitches. The space created may subsequently fill with scar tissue. 

What happens after surgery?

After the surgery a soft dressing of gauze and tape is placed over the toe and foot. The first MTP joint should be immobilized
Post-surgery X-ray showing space created by arthroplasty of the first MTP joint
followed by early motion to minimize stiffness. Physical therapy may be utilized to increase motion and strength at the first MTP joint. Patients should keep their foot elevated as much as possible to reduce swelling. Stitches are removed at 10 to 15 days, depending on the condition of the skin. Patients are then encouraged to wear a hard-sole shoe.

Potential Complications

There are many known complications. One of the most frequent is failure to relieve pain or preserve motion. Another frequent complication is pain at the base of the second toe, stress fracture of the second metatarsal, or dislocation of the second MTP joint.
Patients may also experience a big toe that lacks power and function. This “floppiness” may bother patients during even mild activities such as dancing. Other complications include delayed wound healing, recurrent deformity, bony overgrowth, disintegration of bone, instability of the joint and injury to the nerves of the big toe.
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. 

Frequently Asked Questions

Will I have to be off of my foot?
Rehabilitation protocols vary from surgeon to surgeon. There may be a brief period of time where you should not weight bear, but in general you will get back to limited walking within a few weeks after your surgery. 
When can I return to work?
It depends on the requirements of your occupation and your individual pain tolerance. When you can tolerate pain without pain medication and you are able to walk without assistive devices you can return to a sedentary occupation (desk work, etc.). For more physically strenuous jobs, the time until it is safe to return to work will be longer, perhaps as long as 12 weeks. You and your physician will decide when it is right for you to return to work.

Can I play sports after first MTP resection arthroplasty?
Moderate to strenuous physical activity traditionally has not been possible with this procedure. Light activity, such as walking and cycling, can be performed after the initial healing is complete.
Will first MTP resection arthroplasty improve my range of motion?
You may not get more range of motion than you had prior to surgery.
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