Keck and Kelly procedure involves which of the following?

• A. Lateral malleolus resection
• B. Plantarflexion wedge at calcaneus
• C. Medial column fusion
• D. Dorsally based wedge of posterior calcaneus

Answer: (D)

The principle here is correcting hindfoot deformity by an osteotomy of the calcaneus that reorients the hindfoot mechanics. In the Keck and Kelly procedure, a wedge is taken from the posterior part of the calcaneus with its base on the dorsal (top) aspect. When the osteotomy is closed, the posterior fragment plantarflexes, which repositions the hindfoot from a varus/cavovarus alignment toward a more balanced hindfoot position. This dorsal-based posterior wedge specifically achieves that plantarflexion of the posterior calcaneus to correct the hindfoot deformity, which is why it’s the characteristic feature of this procedure.

The other options don’t fit this technique: resecting the lateral malleolus isn’t a corrective maneuver for hindfoot cavus/varus; a plantarflexion wedge at the calcaneus implies a different wedge orientation and effect than the dorsal-based approach described here; medial column fusion targets the forefoot arch and midfoot alignment rather than a hindfoot osteotomy; and a dorsally based wedge of the posterior calcaneus is precisely what defines the Keck and Kelly procedure.