Reconstructing the rheumatoid forefoot

Area of Science:

• Orthopaedic Surgery
• Rheumatology
• Foot and Ankle Reconstruction

Background:

• Rheumatoid forefoot deformity commonly requires surgical intervention.
• Standard treatment involves resection arthroplasty of metatarsophalangeal joints.
• Repositioning of metatarsophalangeal subluxation/dislocation is an alternative technique.

Purpose of the Study:

• To evaluate the clinical outcomes of forefoot reconstruction using the repositioning technique.
• To compare results with and without concurrent hallux arthrodesis.
• To assess patient satisfaction and functional scores post-surgery.

Main Methods:

• Retrospective analysis of 54 feet (39 rheumatoid arthritis patients) undergoing repositioning surgery.
• Concurrent hallux arthrodesis performed in cases of severe hallux deformity.
• Postoperative assessment using American Orthopaedic Foot and Ankle Society (AOFAS) scores and Foot Function Index (FFI).

Main Results:

• Patients undergoing hallux arthrodesis alongside repositioning achieved significantly higher AOFAS scores (69.80) compared to those without (42.2).
• Postoperative FFI scores were lower (better function) in the group with hallux arthrodesis (23.0 vs 43.9).
• Patient satisfaction was markedly higher (93%) when the first metatarsophalangeal joint was fused.

Conclusions:

• Repositioning the metatarsophalangeal joints of the lesser rays is an effective joint-preserving procedure for rheumatoid forefoot reconstruction.
• Combining this technique with hallux arthrodesis yields superior clinical outcomes and patient satisfaction.
• This approach offers a viable alternative to standard resection arthroplasty.