Sustainability of Forefoot Reconstruction for the Rheumatoid Foot

Whitt, Kathie J.; Rincker, Sarah A.; Hyer, Christopher F.

doi:10.1053/j.jfas.2016.02.003

Cited by 9 publications

(8 citation statements)

References 7 publications

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“…Other groups recently demonstrated good outcomes for joint-preserving arthroplasties similar to resection techniques, but likewise, long-term follow-ups are lacking. 14,25,34 Nevertheless, HV and the lesser toes have to be properly addressed and positioned with each operative procedure in order to achieve long-term satisfactory outcomes.…”

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%

“…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 The use of conventional shoes not only is important for patients but also is one of the surgical goals. This follow-up study shows that only about one-third of participants (36.7%) needed custom-made orthopedic shoes after the Tillmann forefoot procedure.…”

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: 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%

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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“…Hoffmann-Clayton recommends the removal of the proximal phalangeal base based on the requirements of alignment and adjustments. Once the resection is complete, alignment is secured with the temporary Kirschner wire fixation (Figure 1(B)) (15). The reconstructed MT heads are covered by a short extensor tendon and dorsal capsular flap.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Rheumatoid Forefoot Reconstruction Following Minimally Invasive Surgery and Hoffmann-Clayton Procedure with Administration of Plasma Rich in Growth Factors - A 3-Year Follow-Up: A Retrospective Study

Hameed¹,

Makinyan²,

Shindiev³

2022

Gac Méd Caracas

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From 80 % to 90 % of foot deformities in adults are due to rheumatoid arthritis. Despite various surgical approaches, early functional and cosmetic results have been the greatest concern among patients. Thus, optimal surgical choice in rheumatoid forefoot correction is of vital importance for better subjective and clinical results. Thus, optimal surgical choice in rheumatoid forefoot correction is of vital importance for better subjective and clinical results. Our work evaluates the results of minimally invasive surgery (MIS) and resection arthroplasty per Hoffmann-Clayton along with the administration of Plasma Rich in Growth Factors (PRGF) in rheumatoid-affected forefoot patients.

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“…3 Resection arthroplasty of the metatarsal head (MTH) combined with arthrodesis of the first MTP joint is a well-established procedure used to treat severe forefoot deformities in patients with long-standing RA. [4][5][6][7] However, it may involve sacrifice of a normal MTH and has been associated with higher rates of recurrent callosities and subluxations or dislocations of the MTP joint of the lesser toe than joint-preserving procedures. 8,9 We have been performing shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first MTP joint for severe hallux valgus and/or destruction of the first MTP joint with mild or moderate destruction of the lesser MTP joints.…”

Section: Introductionmentioning

confidence: 99%

Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities

Horita

Nishida

Nasu

et al. 2022

J Orthop Surg (Hong Kong)

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Purpose We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities. Methods 17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores. Results Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group ( p < .001) and from 50.1 to 74.2 in the MTH preservation group ( p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation. Conclusion Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.

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Sustainability of Forefoot Reconstruction for the Rheumatoid Foot

Cited by 9 publications

References 7 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

Rheumatoid Forefoot Reconstruction Following Minimally Invasive Surgery and Hoffmann-Clayton Procedure with Administration of Plasma Rich in Growth Factors - A 3-Year Follow-Up: A Retrospective Study

Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities

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