Abstract
We evaluated 4 feet in 3 patients (all females) who underwent surgical treatment for rheumatoid forefoot deformities between December 2008 and June 2009. The average age of the patients was 53.3 years, and the mean follow-up period was 8.3 months. Shortening oblique osteotomy of the metatarsal neck of the lateral toes was performed for all 4 feet. Two feet of 2 patients were subjected to arthroplasty with a Swanson implant in the first metatarsophalangeal joint. In the remaining 2 feet in 2 patients, Mitchell's osteotomy was performed in the first metatarsophalangeal joint. X-ray assessment was performed using the hallux valgus angle (HVA), 1st-2nd intermetatarsal angle (M1-M2), and 1st-5th intermetartarsal angle (M1-M5). Clinical assessment was performed using the rheumatoid arthritis foot and ankle scale, hallux scale, and lesser toe scale, as recommended by the Japanese Society for Surgery of the Foot (JSSF). The average HVA, M1-M2 and M1-M5 improved postoperatively. Good clinical results were confirmed using the JSSF scales in all patients. Resection arthroplasty has often been performed for rheumatoid forefoot deformities. However, we think that shortening oblique osteotomy of the lateral toes and either flexible hinge toe implant arthroplasty or Mitchell's osteotomy of the great toe should be considered as a surgical reconstruction option for rheumatoid forefoot deformities.
