We have made a retrospective comparison between the results of 37 Keller's arthroplasties and 36 distal transverse first metatarsal osteotomies performed in female patients between the ages of 25 and 50 years, for the treatment of hallux valgus. The choice of operation depended on the policy of the consultant responsible for treatment, but analysis of the preoperative findings showed that the two groups were similar, allowing comparative assessment of Keller's procedure in the younger middle-aged patient. All patients were assessed 3 to 5 years after operation using an objective scoring system of symptoms, clinical examination, anteroposterior standing radiographs and walking footprints from a Harris Beath mat. The results following a Keller's arthroplasty were excellent in 7 (19%), good in 22 (60%), poor in 6 (16%), and needed revision in 2 cases (5%). In the osteotomy group, 11 (30.5%) were excellent, 19 (52.5%) were good, 5 (14%) were poor, and 1 (3%) required revision.
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