Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

• Published in: International orthopaedics Vol. 37; no. 9; pp. 1719 - 1729
• Main Authors: Louwerens, Jan Willem K., Schrier, Joost C. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2013
• Subjects: Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - physiopathology; Arthritis, Rheumatoid - surgery; Biomechanical Phenomena; Foot Deformities, Acquired - diagnosis; Foot Deformities, Acquired - physiopathology; Foot Deformities, Acquired - surgery; Humans; Medicine; Medicine & Public Health; Orthopedics; Range of Motion, Articular; Review; Review Article; Rheumatoid forefoot deformity; Preservation of metatarsal heads; Fusion of first metatarsophalangeal joint
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-013-2014-2

Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.