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Rheumatoid forefoot reconstruction. A long-term follow-up study.
1St Alphonsus Regional Medical Center, Boise, Idaho 83706, USA. footmd@aol.com
The Journal of Bone and Joint Surgery. American Volume
|March 21, 2000
Summary
Reconstruction of the rheumatoid forefoot using arthrodesis of the first metatarsophalangeal joint and resection arthroplasty of lesser metatarsal heads provides stable repair. This surgical approach yields a high success rate for patients with severe rheumatoid forefoot deformities.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Podiatry
Background:
- Severe rheumatoid forefoot deformities significantly impact patient mobility and quality of life.
- Surgical reconstruction aims to correct deformities and alleviate pain.
Purpose of the Study:
- To evaluate the outcomes of a combined surgical technique for rheumatoid forefoot reconstruction.
- Specifically assessing arthrodesis of the great toe's metatarsophalangeal joint, resection arthroplasty of lesser metatarsal heads, and hammer toe repair.
Main Methods:
- Retrospective analysis of 32 patients (47 feet) with severe rheumatoid forefoot deformities.
- Procedures included first metatarsophalangeal joint arthrodesis, lesser metatarsal head resection, and proximal interphalangeal joint arthrodesis for hammer toes.
Main Results:
- Successful fusion of all first metatarsophalangeal joints achieved.
- Significant reduction in lesser metatarsophalangeal joint dislocations (70% to 7%).
- High patient satisfaction with excellent (23 feet) or good (22 feet) subjective outcomes.
- Average American Orthopaedic Foot and Ankle Society score of 69; minimal postoperative pain and functional limitations reported.
Conclusions:
- Combined surgical approach offers a stable and effective solution for rheumatoid forefoot reconstruction.
- High success rates and patient-reported outcomes observed at an average of six years post-surgery.
- The technique effectively corrects deformities, reduces dislocations, and improves function.