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Surgical management of the forefoot in patients with rheumatoid arthritis - a review article.

Nash WJ, Al-Nammari S, Khan WS, Pengas IP - Open Orthop J (2015)

Bottom Line: Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints.While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike.It also describes the role of the multidisciplinary team in the management of these patients.

View Article: PubMed Central - PubMed

Affiliation: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK.

ABSTRACT
Foot and ankle pathologies cause a significant disease burden on rheumatoid patients. Forefoot pathologies causes pain, callosities and possibly ulceration, and can cause problems with footwear. Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints. While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike. This review assesses the role of joint preserving osteotomies and arthrodesis, as well as associated complications. It also describes the role of the multidisciplinary team in the management of these patients.

No MeSH data available.


Related in: MedlinePlus

(a) Pre-operative forefoot with significant hallux valgus and disloacation of the 2nd and 3rd MTPJs, (b) Post-operative forefoothaving undergone joint preserving Scarf and Akin osteotomy with incomplete correction combined with lesser metatarsal Weil’sosteotomies.
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Figure 2: (a) Pre-operative forefoot with significant hallux valgus and disloacation of the 2nd and 3rd MTPJs, (b) Post-operative forefoothaving undergone joint preserving Scarf and Akin osteotomy with incomplete correction combined with lesser metatarsal Weil’sosteotomies.

Mentions: First metatarsal osteotomy (Scarf/Chevron/Hohman) - Joint preserving surgery is becoming more popular in the rheumatoid foot, providing stable correction of deformity along with maintaining mobility of the joint (Fig. 2). This will not always be applicable to all patients especially those with significant stiffness, joint destruction, or secondary degenerative changes. In mild to moderate hallux valgus disease, this provides significant improvement in hallux valgus angle and patient reported outcomes. Barouk et al. (2007) reported 95% good correction with Scarf osteotomy at 2 years in 55 patients with rheumatoid hallux valgus [21] Niki et al. (2010) reported improvement in JSSF from 52 to 89 at 3 years follow-up with hallux valgus correction improving from 47 to 9 degrees post-operatively [22]. Bhavikatti et al. (2012) reported similar improvements in American Orthopaedic Foot and Ankle Society (AOFAS) score from 39 to 88, and in the hallux valgus angle from 32 to 14 degrees at a longer follow-up period of 51 months [23]. Modified Mann proximal crescentric osteotomy was used by Takakubo et al. (2010) in significant hallux valgus resulting in improved patient reported outcome measures (JSSF improved from 44 to 72) and a correction of the hallux valgus angle (39 to 29 degrees) in 11 feet at 3.6 years. They reported 3 cases of recurrence of hallux valgus (27%) [24]. Overall complications were relatively few. In the study by Barouk et al., only one patien had to be revised to an arthrodesis (1.8%) [21], while the studies by Niki et al. and Bhaviktti et al. reported rates of residual stiffness as 28.2% and 22.4% respectively [22, 23].


Surgical management of the forefoot in patients with rheumatoid arthritis - a review article.

Nash WJ, Al-Nammari S, Khan WS, Pengas IP - Open Orthop J (2015)

(a) Pre-operative forefoot with significant hallux valgus and disloacation of the 2nd and 3rd MTPJs, (b) Post-operative forefoothaving undergone joint preserving Scarf and Akin osteotomy with incomplete correction combined with lesser metatarsal Weil’sosteotomies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384227&req=5

Figure 2: (a) Pre-operative forefoot with significant hallux valgus and disloacation of the 2nd and 3rd MTPJs, (b) Post-operative forefoothaving undergone joint preserving Scarf and Akin osteotomy with incomplete correction combined with lesser metatarsal Weil’sosteotomies.
Mentions: First metatarsal osteotomy (Scarf/Chevron/Hohman) - Joint preserving surgery is becoming more popular in the rheumatoid foot, providing stable correction of deformity along with maintaining mobility of the joint (Fig. 2). This will not always be applicable to all patients especially those with significant stiffness, joint destruction, or secondary degenerative changes. In mild to moderate hallux valgus disease, this provides significant improvement in hallux valgus angle and patient reported outcomes. Barouk et al. (2007) reported 95% good correction with Scarf osteotomy at 2 years in 55 patients with rheumatoid hallux valgus [21] Niki et al. (2010) reported improvement in JSSF from 52 to 89 at 3 years follow-up with hallux valgus correction improving from 47 to 9 degrees post-operatively [22]. Bhavikatti et al. (2012) reported similar improvements in American Orthopaedic Foot and Ankle Society (AOFAS) score from 39 to 88, and in the hallux valgus angle from 32 to 14 degrees at a longer follow-up period of 51 months [23]. Modified Mann proximal crescentric osteotomy was used by Takakubo et al. (2010) in significant hallux valgus resulting in improved patient reported outcome measures (JSSF improved from 44 to 72) and a correction of the hallux valgus angle (39 to 29 degrees) in 11 feet at 3.6 years. They reported 3 cases of recurrence of hallux valgus (27%) [24]. Overall complications were relatively few. In the study by Barouk et al., only one patien had to be revised to an arthrodesis (1.8%) [21], while the studies by Niki et al. and Bhaviktti et al. reported rates of residual stiffness as 28.2% and 22.4% respectively [22, 23].

Bottom Line: Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints.While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike.It also describes the role of the multidisciplinary team in the management of these patients.

View Article: PubMed Central - PubMed

Affiliation: University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK.

ABSTRACT
Foot and ankle pathologies cause a significant disease burden on rheumatoid patients. Forefoot pathologies causes pain, callosities and possibly ulceration, and can cause problems with footwear. Forefoot correction in rheumatoid patients has historically comprised of excision of diseased joints. While satisfaction was high with this procedure, complications, changing expectations and improvement in medical therapy have raised expectation of patients, physicians and surgeons alike. This review assesses the role of joint preserving osteotomies and arthrodesis, as well as associated complications. It also describes the role of the multidisciplinary team in the management of these patients.

No MeSH data available.


Related in: MedlinePlus