[The child's foot in juvenile polyarthritis (cP)]

The foot, with particular involvement of the ankle joint and forefoot, is an early and frequent site of inflammatory changes in juvenile rheumatoid arthritis. According to the type of disease (sero+ or sero-, polyarticular or pauciarticular, HLAB-27 positive), there is a great variety of symptoms and also of prognoses. The involvement of growth cartilage is the cause of an additional deforming factor over and above the usually progressive process. Varus and cavovarus deformities with clawtoes occur most frequently. Owing to the thickness of the joint cartilage, there is mostly no severe functional deficiency; if there is it often occurs only some what late. On the other hand, extensive bony fusions belong to the characteristic picture of certain forms of juvenile rheumatoid arthritis. Since pain occurs only in the presence of severe deformities due to localized pressure, it is rather seldom that patients with juvenile rheumatoid arthritis come for surgical treatment of their feet. Therefore, it is all the more important to point out the justification of synovectomy in all of these cases, where swelling cannot be removed by conservative measures and in the presence of signs of progressive destruction. Correction of deformities can be achieved by surgery aiming at soft tissue release and osteotomy, partly avoiding arthrodesis. The latter serves to correct fixed deformities and those that disturb function at the end of the growth period.