Forefoot Surgery in Rheumatoid Arthritis: Subjective Assessment of Outcome

Abstract

Forefoot surgical outcomes were evaluated in 26 patients with rheumatoid arthritis. A total of 45 procedures were reviewed with emphasis on first ray intervention. Disease duration and aggressiveness of preceding medical therapy were combined to establish a disease severity index. Patients operated were predominantly in the midrange of disease severity. Subjective data on the relief of pain, callus, and deformity were favorable but this benefit was not long lasting inasmuch as patients were most satisfied in the period immediately following surgery and less so as time elapsed from intervention. Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.

Mid-term results of joint-preserving procedures by a modified Mann method for big toe deformities in rheumatoid patients undergoing forefoot surgeries

“…However, arthrodesis or resection arthroplasty of the MTP joint has mostly been indicated for rheumatoid forefoot deformities [1,4,5] because the elevated disease activity of RA was mostly prolonged during the study period of their series, and seemed to result in the progression of joint destruction.…”

“…A variety of operative procedures have been reported for forefoot deformities of non-rheumatoid arthritis (RA) patients but, to date, reports on resection arthroplasty and arthrodesis of the metatarsophalangeal (MTP) joint only appear in the results of long-term follow-up series for rheumatoid forefoot deformities [1,[3][4][5].…”

The foot

“…When the MTP joints of the toes are relatively well preserved, osteotomy of the meta- [2,17,35,49]. The early gains in function and pain relief, however, seem to decline with longer observation times [19,44]. Callosities occur under unevenly and insufficiently shortened metatarsal bones, and also osteophytes may be formed causing the same result.…”

“…This retrospective study is, however, also lacking a clear classification of the treated forefoot. What is needed in the future is both randomized prospective studies to compare different surgical methods and longer followup times after forefoot surgery [19,44].…”

“…In this respect, arthrodesis seems preferable [19,36]. A disadvantage of arthrodesis is the increased risk for interphalangeal joint destruction, either by peroperative trauma of axial pins or later by increased pressure as the foot concludes the stepping motion [2,34].…”