The authors present the combined use of the Keller bunionectomy with the Austin osteotomy in select cases. Severe degenerative joint disease and metatarsus primus varus with fair to good bone stock are the major criteria. This procedure offers an alternative for the elderly patient who is not a candidate for joint salvage, implant or base osteotomy. Preoperative, intraoperative and postoperative biomechanical evaluations are essential to the success of this procedure.