Keller procedure for the treatment of resistant plantar ulceration of the hallux

A retrospective chart review was performed on 11 patients (13 feet) who underwent a modified Keller procedure for the treatment of recalcitrant neuropathic diabetic ulcers to the plantar aspect of the hallux between 1994 and 1998 to evaluate the postoperative results and complications. Diabetic patients with hallux rigidus, adequate vascular status, documented peripheral neuropathy, and at least 6 months of conservative care for treatment of a Wagner grade I and II ulceration were included in the study. Patients with active soft tissue infections or osteomyelitis were excluded. All primary ulcers healed within 6 months postoperatively. After 1-year of follow-up, 8 feet remained completely free of ulcers and 5 transfer ulcers occurred. Four infections developed; 3 from the surgical wound and 1 from a transfer ulcer. Based on these findings, the modified Keller procedure may be an appropriate intervention for hallux ulcerations provided the surgeon and the patient are aware of its limitations and possible outcomes.