Surgical treatment of hallux valgus deformity in rheumatoid arthritis: Clinical and radiographic evaluation of modified lapidus technique

Shi, Kenrin; Hayashida, Kenji; Tomita, Tadanori; Tanabe, Makoto; Ochi, Takahiro

doi:10.1016/s1067-2516(00)80073-3

Cited by 26 publications

(18 citation statements)

References 24 publications

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“…Shi et al [35] assessed the outcomes of the procedure in 21 patients with rheumatoid arthritis. They report pain relief and the possibility to wear normal shoes.…”

Section: Discussionmentioning

confidence: 99%

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

Popelka

Hromádka

Vavřík

et al. 2012

BMC Musculoskelet Disord

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BackgroundFoot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.MethodsThe study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray.ResultsData of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%).ConclusionThe Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

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“…Shi et al [35] assessed the outcomes of the procedure in 21 patients with rheumatoid arthritis. They report pain relief and the possibility to wear normal shoes.…”

Section: Discussionmentioning

confidence: 99%

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

Popelka

Hromádka

Vavřík

et al. 2012

BMC Musculoskelet Disord

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“…Again, after advising the patients that the joint may become arthritic in the future and about the risk of recurrent deformity, in individual cases with a non-arthritic first MTP joint, it seems justified to correct a hallux valgus deformity using standard techniques in order to restore or maintain a normal function of the first MTP joint and the weight-bearing function of the first ray. Among these techniques a Lapidus fusion of the first metatarsal-cuneiform joint in combination with a soft tissue procedure of the first MTP joint in cases with unstable tarsometatarsal joint destruction should be considered [71]. For patients with a clearly diseased first MTP joint a choice must be made between fusion, resection or replacement through an implant of the first MTP joint.…”

Section: The First Raymentioning

confidence: 99%

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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“…Its main use is in patients with a hypermobile 1st ray. Shi et al described their modified technique for the Lapidus procedure in patients with RA [55]. They achieved good to excellent pain relief in 80 % of patients.…”

Section: Surgical Managementmentioning

confidence: 99%

The rheumatoid forefoot

Brooks

Hariharan

2013

Curr Rev Musculoskelet Med

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Rheumatoid arthritis (RA) manifests itself in a variety of ways, with its effect being seen in around 90 % of sufferers' feet. The foot has been found to be the most common reason for incapacity in patients with RA, with the forefoot the most common area. The foot is second, behind only the hand, as the most common place for manifestation of RA. Pain in the foot is commonly the most debilitating condition, which causes the patient to seek specialist help. As well as pain, foot deformities such as hallux valgus and claw toes are common complaints. These symptoms often arise as a result of continued walking on an unstable foot, leading to painful callosities and dislocation of the metatarsophalangeal joints. Other conditions, such as pannus formation and Morton's neuroma, can be related to RA. This review sets out what we believe to be a successful approach to the rheumatoid forefoot, which aims at the relief of pain and the preservation of ambulation. Key to a successful outcome is appropriate medical control with a multidisciplinary approach that enables close liaison between orthopaedic surgeons, orthotists, and rheumatologists. Combined clinics provide this multidisciplinary care. Those treating RA need to be aware of the high incidence of foot involvement and how early intervention may benefit the patient. The aim of this article is to present current evidence to enable people to develop a treatment algorithm for this condition.

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Surgical treatment of hallux valgus deformity in rheumatoid arthritis: Clinical and radiographic evaluation of modified lapidus technique

Cited by 26 publications

References 24 publications

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

The rheumatoid forefoot

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