[Surgical treatment of the rheumatoid forefoot by realignment using th dorsal approach]

The aim of this study was to appreciate the results of the modified Fowler's procedure in the surgical treatment of forefoot deformities due to rheumatoid arthritis.

If the principles of the metatarsophalangeal resection through a dorsal transverse incision were conserved, we progressively modified the initial procedure with renunciation to the plantar skin incision, preservation of a skin bridge between the medial and transverse dorsal approach, using centro medullary pins to hold in position toes alignment and making an arthrodesis of the first metatarsophalangeal joint. Ten patients (17 surgical procedures) were clinically and roentgenographically reviewed at an average follow-up of 27.3 months (Range : 12 and 53 months).

Clinical results according to the Gainor scale showed an increase of the overall score from 3.4 points to 11.2 points at revision. Twelve foot were rated excellents and five goods. Seventy per cent of patients had no pain and 58 per cent used a normal footwear. Radiographical and clinical analysis showed that an egyptian foot remained in nine cases, podoscopic examination revealed frequently a lack of footrest on lateral toes without functional implications. Delayed wound healing were observed in four cases with good evolution.

With this surgical procedure, our functional results were encouraging and we recommend it in severe deformities of the rheumatoid foot with fixed metatarsophalangeal dislocations and bone defect of the metatarsal heads.