Reconstruction of Rheumatoid Forefoot Deformity

Sung, Il Hoon; Lee, Ahm

Abstract

OBJECTIVE
The purpose of the present study was to assess the short term result of the reconstruction of forefoot deformity, commonly seen in rheumatoid patients.
METHODS
15 patients (20 feet) were evaluated and the average follow up period was 18.4 months. The reconstructive procedure included the arthrodesis of the first metatarsophalangeal joint of hallux, the lesser metatarsophalangeal resection arthroplasty, and extensor tenotomy of lesser toes. The subjective and the objective findings were studied, using the rating scale of The American Orthopaedic Foot and Ankle society, and the radiological measurement.
RESULTS
Subjective assessment with respect to pain, function, alignment was excellent in ten feet (50%), good in ten feet (50%), and no fair and poor. The hallux valgus angle (HVA) and 1st intermetatarsal angle were improved from 48.4+/-4.23 and 16.5+/-2.08 to 13.5+/-1.96 and 11.0+/-1.28 degrees respectively. The average dorsiflexion angle was 18.95+/-2.20 degrees. All arthrodesis site were fused within average 8 weeks after operation. The overall complication of the procedure was few and reoperation was none.
CONCLUSION
The reconstructive procedure, including the arthrodesis of the first metatarsophalangeal joint and the lesser metatarsophalangeal resection arthroplasty with extensor tenotomy was regarded as a good option for treating a rheumatoid forefoot deformity surgically.