Review of the results of excision of the metatarsal heads in patients with rheumatoid arthritis.

Abstract

In one set of experiments the harvesting was done on the 5th day and in the other on the 6th day. Might this not account for wide variation in the uptake of thymidine? DR. DAVEY In the first group of experiments we did not find any marked difference in the results, whether cultures were harvested at day 5 or day 6, but this is clearly very late in lymphocyte culture time and there tended to be a fairly wide variation. It is late even for antigen stimulation, and I think that in some of the cultures the pH had dropped so much that we were getting rather slight effects. Of the fourteen in Grade II, eight had persistent pain as a result of pressure on a metatarsal remnant, four had discomfort attributed to wound infection, one had persistent hallux rigidus on one side, and in one the cause of pain was not obvious. Review of the Results of Excision of the MetatarsalIn the fifteen in Grade III, the poor results were attributed to irregular resection of the metatarsals in nine, inappropriate operation in three, and no obvious cause in three.The fact that in 80 per cent. of feet operated on symptoms were abolished and the wearing of normal shoes made possible makes this procedure one of the most reliable in the treatment of rheumatoid arthritis. Discussion

Metatarsal head preservation in forefoot arthroplasty and the correction of severe claw toe deformity

“…Apart from the one patient (2%) who developed deformity in a fifth toe which had not been operated on, no patient required reoperation on the forefoot after multiple toe procedures. This contrasts with studies of metatarsal head excision techniques in which reoperation rates of 8–36% are quoted [15–35], including series in which first metatarsophalangeal arthrodesis has been performed [17, 30].…”

Interventions for foot disease in rheumatoid arthritis: A systematic review

“…The main risk of harm reported was infection, which was specifically reported in 8 surgical observational studies (29,31,32,35,39,40,42,43); the frequency of infection in these reports averaged 7.5% (range 1.4 -16%). Individual reports also described delayed wound healing (31,35), skin necrosis (41), and implant fragmentation (31).…”

“…Improvements in walking ability ranged from 67% to 80% in the remaining 4 studies (36,40). Footwear improvement was noted in 25% of patients (36) and ordinary shoe wear was possible in 45-80% (40,41) of patients postoperatively.…”

Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities

“…Several methods of treating the hallux valgus deformity in RA have been reported, including arthrodesis, joint resection, and arthroplasty with implant for the MTP joint. Good results have been observed in previous surgical procedures [4][5][6][7][8][9][10]. However, a number of authors have found a significant rate of recurrent symptomatic deformities of both the hallux valgus and lesser toes [8,10,11] over time when the hallux valgus deformity is managed by resection-type arthroplasty of the MTP joint.…”