Keller's Gap Arthroplasty for Plantar Hallux Interphalangeal Joint Ulcer in Diabetes: A Limb Preserving Solution

Correspondence: Madhan Subashchandrabose (E-mail: [e-mail])

Abstract

Background Plantar hallux interphalangeal (IP) joint ulcer in diabetic patients is prone to recurrence, infection, and amputation risk. Keller's gap arthroplasty, involving resection of the proximal phalanx base, offers joint-sparing offloading while preserving foot function.

Methodology A prospective study was conducted on 18 diabetic patients (mean age: 48 years) with chronic, treatment-refractory plantar hallux IP joint ulcer who underwent Keller's gap arthroplasty between September 2023 and May 2025. Outcome measures included ulcer healing rates, time of healing, recurrence, complications, and ambulatory status. The mean follow-up was 18 months.

Results Complete ulcer healing occurred in all patients, with a mean healing time of 4 to 6 weeks. At final follow-up, 90% maintained functional ambulation without ulcer recurrence. No major complications or proximal amputations were reported. Minor functional limitations were noted in a few cases, but did not impair daily activities.

Conclusion Keller's gap arthroplasty provides effective pressure offloading at the plantar hallux IP joint, enabling rapid ulcer healing and preventing higher-level amputations in diabetic patients. it is a simple, reliable, and limb-preserving option for a recalcitrant ulcer.

Keywords: diabetic ulcer, hallux IP joint, Keller's arthroplasty, limb salvage, ulcer recurrence

Publikationsverlauf

Artikel online veröffentlicht:
10. November 2025