Dwyer's operation for the rheumatoid forefoot

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Podiatry

Background:

• Severe toe deformities can significantly impair foot function and quality of life.
• The Dwyer procedure, described in 1970, aims to correct these deformities through joint fusion and tendon interposition.
• Rheumatoid arthritis frequently causes severe toe deformities, necessitating surgical intervention.

Purpose of the Study:

• To evaluate the efficacy of the Dwyer procedure in treating severe toe deformities in rheumatoid patients.
• To assess patient satisfaction, pain relief, and functional outcomes following the surgical intervention.
• To objectively evaluate the surgical results, including joint fusion and toe alignment.

Main Methods:

• A consecutive series of 36 Dwyer procedures were performed on 22 rheumatoid patients.
• Follow-up was conducted on 33 operations in 20 patients, averaging 42.2 months.
• Assessment included subjective patient reports (satisfaction, pain, shoe fit, cosmesis, walking) and objective examination (arthrodesis, toe position, callosities, symmetry).

Main Results:

• Good or excellent results were achieved in 76% of the procedures.
• Satisfactory outcomes were reported in 12% of cases.
• Poor results were observed in 12% of the procedures.

Conclusions:

• The Dwyer procedure offers a viable surgical option for correcting severe toe deformities in rheumatoid arthritis.
• The procedure demonstrates a high rate of success in improving foot stability, function, and patient satisfaction.
• Further evaluation may be warranted for cases with poor outcomes to refine surgical techniques or patient selection.