A, Anteroposterior radiograph of right foot of 65-year-old patient shows mild-to-moderate deformity and mild degenerative changes at first metatarsophalangeal joint; patient had intraarticular and periarticular symptoms. B, Twelve years after Keller procedure with excision of fibular sesamoid; note correction of first metatarsal varus and maintenance of enough joint space to allow functional range of motion.