S12 RECONSTRUCTING THE RHEUMATOID FOREFOOT

Abstract

Introduction: The standard procedure when operating the rheumatoid forefoot is resection arthroplasty of the metatarsophalangeal joints of the lesser rays. Correction of the hallux is mostly achieved by arthrodesis of the first metatarsophalangeal joint. Good clinical results (with a follow-up of over ten years) have been reported when a combination of these two techniques is used. Another technique is repositioning of the metatarsophalangeal subluxation or dislocation of the lesser rays, thereby preserving the metatarsophalangeal joints, thus leaving the function of the aponeurosis plantaris intact. As a result of this it can be expected that unrolling of the forefoot is unaffected and therefore a better function of the forefoot remains.

Aim: To assess the results of forefoot reconstruction using the repositioning technique performed in 54 feet (39 patients) by one surgeon using this technique.

Methods: Fifty-four feet (39 RA patients) were treated with the technique of repositioning the metatarsophalangeal subluxation or dislocation. All surgery was performed by one orthopaedic surgeon. In case of severe deformity of the metatarsophalangeal joint of the hallux, an arthrodesis was performed. All patients were reviewed after a mean follow up of 40 months (range 12–72 months) and an AOFAS [American Orthopaedic Foot and Ankle Society] foot score, and FFI [Foot Function Index] were obtained.

Results: At a mean of 40 months (SD=15.6 months) postoperatively, the mean AOFAS forefoot score was 69.80 (SD=11.8) if, in addition of repositioning the metatarsophalangeal joints, an arthrodesis of the hallux was performed. In patients with no operation on the hallux, the AOFAS score was 42.2 (SD=18.8) (P=0,001). The postoperative FFI-scores were 74.0 (SD=17.5) and 57.6 (SD=14.6) respectively (P=0,026)

Conclusions: Reconstruction of the rheumatoid forefoot by repositioning the metatarsophalangeal joints of the lesser rays, thereby preserving the joints, can be considered a procedure that provides improvement in the clinical outcome. Best results were seen in patients in whom, in addition of reconstruction of the lesser rays, an arthrodesis of the hallux was performed.