Background: Rheumatoid arthritis commonly affects the forefoot,
causing metatarsalgia, hallux valgus, and deformities of the lesser toes.
Various types of surgical correction have been described, including resection
of the lesser-toe metatarsal heads coupled with arthrodesis of the great toe,
resection arthroplasty of the proximal phalanx or metatarsal head, and
metatarsal osteotomy. We report the results at an average of five and a half
years following thirty-seven consecutive forefoot arthroplasties performed in
twenty patients by one surgeon using a technique involving resection of all
five metatarsal heads.
Methods: All patients were treated with the same technique of
resection of all five metatarsal heads through three dorsal incisions. All
surviving patients were asked to return for follow-up, which included
subjective assessment (with use of visual analogue pain scores, AOFAS
[American Orthopaedic Foot and Ankle Society] foot scores, and SF-12 [Short
Form-12] mental and physical disability scores), physical examination, and
Results: All results were satisfactory to excellent in the short
term (six weeks postoperatively), and no patient sought additional surgical
treatment for the feet. A superficial infection subsequently developed in two
feet, and two feet had delayed wound-healing. At an average of 64.9 months
postoperatively, the average AOFAS forefoot score was 64.5 points and the
average hallux valgus angle was 22.3°. There were no reoperations.
Conclusions: Resection of all five metatarsal heads in patients with
metatarsalgia and hallux valgus associated with rheumatoid arthritis can be a
safe procedure that provides reasonable, if rarely complete, relief of
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.