Forefoot Reconstruction Following Metatarsal Head Resection Arthroplasty With a Plantar Approach—A 20-Year Follow-Up

Abstract

Background: Rheumatoid arthritis (RA) can cause significant forefoot disorders. If forefoot deformity and pain are severe, surgical treatment can be considered. The aim of this study was to analyze the long-term outcomes of surgical forefoot correction per Tillmann, which involves resection of the metatarsal heads through a transverse plantar approach for the lesser toes and a dorsomedial approach to the great toe. Methods: This retrospective study used patient-based questionnaires to analyze the revision rate, pain, use of orthoses, walking ability, forefoot function, and patient satisfaction of patients with RA who had undergone a complete forefoot correction of metatarsophalangeal (MTP) I to V. The study only included participants with RA before the era of biological agents and who were at least 20 years postoperatively. A total of 60 patients who had undergone 100 complete forefoot operations according to Tillmann 24.6 ± 3.5 years ago were included in this study. Results: The data collected showed that 35 reoperations were performed on 26 of the patients. Deformity relapses were often documented for the hallux valgus. More than 60% of the patients were able to wear conventional shoes. The distances the participants were able to walk were significantly increased by wearing shoes when compared with walking barefoot ( P < .01). Conclusion: While forefoot function remained difficult to assess, the majority of patients were able to use conventional shoes. This long-term follow-up study of patient-reported questionnaires completed more than 20 years after the Tillmann procedure showed that more than 80% of the patients remained satisfied with the outcome. Level of Evidence: Level IV, retrospective cohort study.

Distal Metatarsal Segmental Shortening for the Treatment of Chronic Metatarsophalangeal Dislocation of Lesser Toes

“…21 Resection arthroplasty through plantar approach offered good results, including reducing pain and improving ambulation, in a 20-year long-term follow-up study in which more than 80% of patients felt satisfied with the outcome. 23 Despite good results reported with resection arthroplasty, some surgeons may still prefer to use modified metatarsal shortening offset osteotomy for joint preservation even in rheumatoid cases. 10 Therefore, resection arthroplasty was not considered for chronic metatarsophalangeal dislocation of deformed lesser toes in our nonrheumatoid patients.…”

Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review

“…Recent investigations indicate that patients with RA in the foot and/or ankle commonly receive surgical treatment, which achieves beneficial effects regarding pain relief and enhanced functionality [8,15]. With regard to the specific area of investigation, most of the studies considered focused on the treatment of the forefoot.…”

“…[13,14]. If these approaches do not satisfactorily resolve the pain, deformity, or loss of function, or facilitate the use of conventional shoes, various types of surgical treatment may be proposed [15], regardless of the stage of the disease, to be used initially as prophylaxis, and at more advanced levels to correct deformities, recover foot function, and relieve pain [12,16]. Surgical techniques are most commonly applied to the forefoot [17], but the hindfoot and ankle are also treated [18].…”

Unterschiede in der Therapie entzündlich rheumatischer und degenerativer Füße. Die Vorfußchirurgie

“…Die Kombination der MTP I Arthodese mit Resektionsarthroplastik der übrigen MTP Gelenke gilt als Goldener Standard in der Behandlung rheumatischer Vorfußdeformitäten [6]. Durch die verbesserte Krankheitskontrolle mittels moderner medikamentöser Therapie hat der Schweregrad an radiologischen Veränderungen abgenommen.…”

“…Strahl können einheitlich gute Ergebnisse erzielt werden. So konnte in einer Langzeitstudie von 20 Jahren eine Zufriedenheit der Patienten von 80 % und eine Beschuhbarkeit im Konfektionsschuhwerk von 60 % gezeigt warden [6]. Nachteile ergeben sich in der Ausbildung einer sagittalen Instabilität, ungünstigeren plantaren Druckverhältnissen mit folglich schlechterem Barfußgang.…”