RHEUMATOID FOREFOOT RECONSTRUCTION WITH FIRST METATARSOPHALANGEAL FUSION AND ARTHROPLASTY OF LESSER METATARSAL HEADS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DUAN Xiaojun , YANG Liu , DAI Gang , PENG Xu.

Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, P.R.China.;

Corresponding author：

Keywords：

Rheumatoid arthritis; Forefoot deformity; Arthrodesis; Osteotomy; Reconstruction surgery

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the surgical treatment and effectiveness of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. Methods Between January 2007 and August 2009, 7 patients with rheumatoid forefoot were treated by reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. They were all females with an average age of 62 years (range, 56-71 years) and with an average disease duration of 16 years (range, 5-30 years). All patients manifested hallux valgus, hammer toe or mallet toe of 2-5 toes, 5 feet complicated by subluxation of the second metatarsophalangeal joint. The improved American Orthopaedic Foot amp; Ankle Society (AOFAS) score was 36.9 ± 6.4. The hallux valgus angle was (46 ± 5)°, and the intermetarsal angle was (12 ± 2)° by measuring the load bearing X-ray films preoperatively. Results All incisions healed by first intention after operation. The X-ray films showed bone fusion of the first metatarsophalangeal joint at 3-4 months after operation. Seven patients were followed up 2.9 years on average (range, 2-4 years), gait was improved and pain was rel ieved. The hallux valgus angle decreased to (17 ± 4)° and the intermetarsal angle was (11 ± 2)° at 3 months postoperatively, showing significant differences when compared with preoperative values (P lt; 0.05). The improved AOFAS score was 85.3 ± 5.1 at 2 years postoperatively, showing significant difference when compared with preoperative score (t=4.501, P=0.001). One patient had recurrent metatarsalgia at 4 years after operation. Conclusion Arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads for rheumatoid forefoot reconstruction can correct hallux valgus, remodel the bearing surface of the forefoot, and rel ieve pain, so it can be considered as a procedure that provides improvement in the cl inical outcome.

Citation： DUAN Xiaojun,YANG Liu,DAI Gang,PENG Xu.. RHEUMATOID FOREFOOT RECONSTRUCTION WITH FIRST METATARSOPHALANGEAL FUSION AND ARTHROPLASTY OF LESSER METATARSAL HEADS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(4): 445-448. doi: Copy

1.	过邦辅. 类风湿性关节炎 (十) ——踝关节与足类风湿性关节炎的外科治疗. 中华骨科杂志, 1998, 18(10): 637-640.
2.	Fishman SA. Rheumatoid arthritis with forefoot reconstruction. J Foot Surg, 1989, 28(3): 204-207.
3.	Amin A, Cullen N, Singh D. Rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4.	McKinley JC, Shortt N, Arthur C, et al. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int, 2011, 32(7): 681-685.
5.	Coughlin MJ, Mann RA. Hallux valgus//Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St. Louis: Mosby, 2006: 184-354.
6.	Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum, 1988, 31(3): 315-324.
7.	Bolland BJ, Sauvé PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
8.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9.	McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
10.	Doorn PF, Keijsers NL, van Limbeek J, et al. A clinical classification system for rheumatoid forefoot deformity. Foot Ankle Surg, 2011, 17(3): 158-165.
11.	van Tuyl LH, Britsemmer K, Wells GA, et al. Remission in early rheumatoid arthritis defined by 28 joint counts: limited consequences of residual disease activity in the forefeet on outcome. Ann Rheum Dis, 2012, 71(1): 33-37.
12.	Baan H, Drossaers-Bakker W, Dubbeldam R, et al. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol, 2011, 30(11): 1475-1479.
13.	Miyamoto W, Takao M, Innami K, et al. Technique tip: interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int, 2011, 32(2): 211-214.
14.	van der Heide HJ, Louwerens JW. Reconstructing the rheumatoid forefoot. Foot Ankle Surg, 2010, 16(3): 117-121.
15.	Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg, 2012, 132(4): 477-485.
16.	Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg, 2006, 45(2): 107-112.
17.	Krause FG, Fehlbaum O, Huebschle LM, et al. Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction. Foot Ankle Int, 2011, 32(2): 131-140.
18.	吕厚山, 寇伯龙, 袁燕林, 等. 跖骨头切除的手术方法及疗效分析24例类风湿性关节炎前足矫形. 中华骨科杂志, 1996, 16(1): 31-33.
19.	Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.

1. 过邦辅. 类风湿性关节炎 (十) ——踝关节与足类风湿性关节炎的外科治疗. 中华骨科杂志, 1998, 18(10): 637-640.
2. Fishman SA. Rheumatoid arthritis with forefoot reconstruction. J Foot Surg, 1989, 28(3): 204-207.
3. Amin A, Cullen N, Singh D. Rheumatoid forefoot reconstruction. Acta Orthop Belg, 2010, 76(3): 289-297.
4. McKinley JC, Shortt N, Arthur C, et al. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int, 2011, 32(7): 681-685.
5. Coughlin MJ, Mann RA. Hallux valgus//Coughlin MJ, Mann RA, Saltzman CL, eds. Surgery of the Foot and Ankle. 8th ed. St. Louis: Mosby, 2006: 184-354.
6. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum, 1988, 31(3): 315-324.
7. Bolland BJ, Sauvé PS, Taylor GR. Rheumatoid forefoot reconstruction: first metatarsophalangeal joint fusion combined with Weil’s metatarsal osteotomies of the lesser rays. J Foot Ankle Surg, 2008, 47(2): 80-88.
8. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
9. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
10. Doorn PF, Keijsers NL, van Limbeek J, et al. A clinical classification system for rheumatoid forefoot deformity. Foot Ankle Surg, 2011, 17(3): 158-165.
11. van Tuyl LH, Britsemmer K, Wells GA, et al. Remission in early rheumatoid arthritis defined by 28 joint counts: limited consequences of residual disease activity in the forefeet on outcome. Ann Rheum Dis, 2012, 71(1): 33-37.
12. Baan H, Drossaers-Bakker W, Dubbeldam R, et al. We should not forget the foot: relations between signs and symptoms, damage, and function in rheumatoid arthritis. Clin Rheumatol, 2011, 30(11): 1475-1479.
13. Miyamoto W, Takao M, Innami K, et al. Technique tip: interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int, 2011, 32(2): 211-214.
14. van der Heide HJ, Louwerens JW. Reconstructing the rheumatoid forefoot. Foot Ankle Surg, 2010, 16(3): 117-121.
15. Duan X, Kadakia AR. Salvage of recurrence after failed surgical treatment of hallux valgus. Arch Orthop Trauma Surg, 2012, 132(4): 477-485.
16. Hulse N, Thomas AM. Metatarsal head resection in the rheumatoid foot: 5-year follow-up with and without resection of the first metatarsal head. J Foot Ankle Surg, 2006, 45(2): 107-112.
17. Krause FG, Fehlbaum O, Huebschle LM, et al. Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction. Foot Ankle Int, 2011, 32(2): 131-140.
18. 吕厚山, 寇伯龙, 袁燕林, 等. 跖骨头切除的手术方法及疗效分析24例类风湿性关节炎前足矫形. 中华骨科杂志, 1996, 16(1): 31-33.
19. Rosenbaum D, Timte B, Schmiegel A, et al. First ray resection arthroplasty versus arthrodesis in the treatment of the rheumatoid foot. Foot Ankle Int, 2011, 32(6): 589-594.

Chinese Journal of Reparative and Reconstructive Surgery

RHEUMATOID FOREFOOT RECONSTRUCTION WITH FIRST METATARSOPHALANGEAL FUSION AND ARTHROPLASTY OF LESSER METATARSAL HEADS

Abstract Full text Figures/Tables Video References Cited by

Format

Content