Original Article
Surgical management of the deformed rheumatoid forefoot

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Summary

Forefoot disorders are common in rheumatoid arthritis and difficult to treat. We operated on 25 patients (50 feet), mean age 59 years, using a Keller resection arthroplasty (six feet) (group A) or a Wilson type osteotomy of the first metatarsal (44 feet) (group B), in combination with [1]: an oblique osteotomy of the fifth metatarsal (38 feet) [2]; Helal type osteotomies on the second, third or fourth metatarsal (99 metatarsals) [3]; excisions of the metatarsal heads (35 of the second and 16 of the third) [4]; excision or arthrodesis of the proximal interphalangeal joints in 84 toes; and [5] soft tissues release in 46 feet and elongation of extensor tendons in one or two toes in 20 feet. There was one infection (2%) and delayed wound healing in 12 feet (24%). Mean follow-up was 4.5 years (2–8 years). We evaluated the results according our scoring system, with objective and subjective criteria. In group A, we found one foot with a very good result, three with good and two with fair results. In group B, we found very good results in 31 feet (70.5%), good results in six feet (13.5%) and fair or poor results in seven feet (16%).

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