A Method of Forefoot Reconstruction

Fowler, Allan

doi:10.1302/0301-620x.41b3.507

Cited by 112 publications

(32 citation statements)

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“…), by means of resection of all MT heads, continues to be the most advocated [16]. Fowler and Clayton have modified this procedure and have more or less initiated the present-day total approach to the rheumatoid forefoot deformity underlining the importance of adequate resection of bone, usually all MT heads, with realignment of the remaining weight-bearing ends of the metatarsals [17][18][19][20]. Generally, all the lesser MT heads are resected (Fig.…”

Section: Resection Of the Mt Headsmentioning

confidence: 99%

“…Several incisional approaches have been used, including a transverse or elliptical plantar incision and a dorsal transverse incision, but currently the use of multiple dorsal incisions is the most common [17,18,20,21,24,30,38,45]. A plantar approach allows the removal of plantar calluses and bursae and offers easy access to the MT heads.…”

Section: Resection Of the Mt Headsmentioning

confidence: 99%

“…An argument for routine excision of the first MTP joint is the risk that this joint will be affected by rheumatoid arthritis after time in any event [20,69]. Nowadays pharmacotherapeutic treatment is very successful and the possibility that the first MTP joint remains uninvolved is much higher.…”

Section: The First Raymentioning

confidence: 99%

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Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Louwerens¹,

Schrier

2013

International Orthopaedics (SICOT)

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Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.

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Section: Resection Of the Mt Headsmentioning

confidence: 99%

Section: Resection Of the Mt Headsmentioning

confidence: 99%

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Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Louwerens¹,

Schrier

2013

International Orthopaedics (SICOT)

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“…Fowler (1959) described a patient who as a result of forefoot shortening tended to fall forwards and Barton (1973) recorded a similar case. In the latter's comparison of the techniques of Fowler (1959), Clayton (1967) and Kates et al (1967) overall instability was found to be 20%, more than twice as high as in the procedure described here. Similarly, improvement in stability occurred in fewer patients, only 40%.…”

Section: Discussionmentioning

confidence: 58%

“…The pain relief derived by these operations is almost uniformly good but the foot is shortened by one or two shoe sizes (Marmor 1975) and this is considered by many to initiate or worsen pre-existing unsteadiness (Fowler 1959, Barton 1973. The operation described here does not cause this and possesses the significant advantage that it can be performed on early cases in which the disease is localised to only two or three rays.…”

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confidence: 89%

Conservation of Metatarsal Heads in Surgery of Rheumatoid Arthritis of the Forefoot

Newman

Fitton

1983

Acta Orthopaedica Scandinavica

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Rheumatoid deformity of the foot

Marmor¹,

Larson

Rhinelander

et al. 1963

Arthritis & Rheumatism

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HE PATIENT with rheumatoid arthritis often develops severe, crippling T deformities of his upper and lower limbs. The medical profession has now adopted a more aggressive approach to the correction and prevention of these deformities, especially in the upper extremities. But the deformity of the foot can also be extremely disabling.The patient can not obtain suitable shoes which are comfortable to accommodate his deformed, painful joints. It is indeed a dilemma, since he also can not walk barefoot because of the pain. His problem is compounded in areas of the country where the winters are severe. He is a pathetic sight confined to a wheel chair because of bad feet or shufHing about with severe pain.Deformities of the feet from rheumatoid arthritis can be alleviated by surgical procedures to an extent that is often termed a "miracle" by the postoperative patient. It is time to take stock of this patient and to begin to approach his problems with hope and enthusiasm. DeformitiesThe common foot deformities in rheumatoid arthritis are clawing of the toes, hallux valgus (bunion), and dislocation of the metatarsal phalangeal joints of all of the toes ( fig. 1 ) . These deformities tend to be combined in the severe, advanced case and to produce symptoms that are a consequence more of the mechanical deformity than of the arthritis itself.The dislocation of the toes with contracture of the extensor tendons produces a severe clawing of the toes and forces the metatarsal head down into the plantar surface so that the metatarsal arch is obliterated. The prominence of the metatarsal heads on the sole of the foot produces the severe calluses and pain on walking (Fig. 1B). Combined with the severe clawing and hallux valgus, this makes the fitting of a comfortable shoe almost impossible. TREATMENTIn the severe case almost all conservative measures will meet with little success, although they should be attempted. Soft, pliable leather shoes with a metatarsal bar may be of value in relieving pressure on the metatarsal heads. Special shoes can be constructed from plaster molds of the patient's feet, and although large and bulky, they give the patient considerable relief.If nothing aids the patient, an operation to correct the deformities should be considered, since very good results have been obtained.In 1912, Hoffman1 advocated excision of the metatarsal heads for correction of multiple toe deformities. However, although relief was obtained in many ~ 'Supported in part by a grant from the.Arthritis G Rheumatism FouncEation.

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A Method of Forefoot Reconstruction

Cited by 112 publications

References 0 publications

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Conservation of Metatarsal Heads in Surgery of Rheumatoid Arthritis of the Forefoot

Rheumatoid deformity of the foot

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