Rheumatoid forefoot reconstruction: Outcome of 1st metatarsophalangeal joint fusion and the Stainsby procedure in the lesser toes

Bass, Edward; Shariff, Raheel; Sirikonda, Siva

doi:10.1016/j.foot.2014.02.006

Cited by 4 publications

(15 citation statements)

References 29 publications

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“…Postoperative pain improvement is also addressed by other procedures. 1,3,7,24 This follow-up study shows that 35% of patients were pain-free while approximately 40% of patients had pain under strain. This is most probably the limiting factor for the reduced barefoot walking distances for the larger part of the group.…”

Section: Discussionmentioning

confidence: 77%

“…27 Instead of resecting the metatarsal heads, the Stainsby operation resects the base of the proximal phalanges and repositions the dislocated plantar plate beneath the metatarsal heads. 1,3 It has been reported that the Stainsby operation results in good satisfaction rates, with 50% of participants in the study by Hassan et al being completely satisfied, and 34% of participants being satisfied with some reservations, while 20% of the participants still reported significant forefoot pain in a midterm follow-up of 32 months. 11 These respectable results were confirmed by other authors in short-to midterm follow-up studies.…”

Section: Discussionmentioning

confidence: 95%

“…11 Others, such as Bass et al and Kadambande et al, advocate strongly for a primary arthrodesis of the MTP I joint due to increased stability of the MTP I joint and weightbearing possibility plus increased protection of the lesser toes after reconstructive surgery. 1,16 In contrast, others support a combined osteotomy and soft tissue reconstruction and have had good results with that. 1,16,18 In the authors’ experience, a mere osteotomy and soft tissue reconstruction should be limited to mild HV angles of less than 40 degrees with good redressing intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…1,16 In contrast, others support a combined osteotomy and soft tissue reconstruction and have had good results with that. 1,16,18 In the authors’ experience, a mere osteotomy and soft tissue reconstruction should be limited to mild HV angles of less than 40 degrees with good redressing intraoperatively. However, in cases of severe joint deviations of 40 degrees or more of the HV angle, the authors suggest, with regard to the current results, primary arthrodesis of the MTP I joint in order to avoid deformity relapse.…”

Section: Discussionmentioning

confidence: 99%

“…This opinion aligns with Bass et al and Whitt et al, who used a primary fusion technique for all HV in forefoot deformity surgery. 1,34…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…This opinion aligns with Bass et al and Whitt et al, who used a primary fusion technique for all HV in forefoot deformity surgery. 1,34…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2019

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Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

Schrier

Keijsers

Matricali

et al. 2019

Foot and Ankle Surgery

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Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review

et al. 2023

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Purpose A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus. Material and methods A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score. Results Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen. Conclusion Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.

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Rheumatoid forefoot reconstruction: Outcome of 1st metatarsophalangeal joint fusion and the Stainsby procedure in the lesser toes

Cited by 4 publications

References 29 publications

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

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

Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial

Non-union incidence of different joint preparation types, joint fixation techniques, and postoperative weightbearing protocols for arthrodesis of the first metatarsophalangeal joint in moderate-to-severe hallux valgus: a systematic review

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