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Kim SJ, Gil YW, Sung IH. Preoperative patient's expectations and clinical outcomes after rheumatoid forefoot deformity reconstruction by joint sacrificing surgery. JOURNAL OF RHEUMATIC DISEASES 2024; 31:33-40. [PMID: 38130962 PMCID: PMC10730808 DOI: 10.4078/jrd.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
Objective To study the clinical and radiologic factors related with overall patient satisfaction of joint scarifying reconstruction on severe rheumatoid forefoot deformity (RFD). Methods Forty cases of RFD were retrospectively enrolled. A questionnaire on the factors for patient's expectations and satisfactions of the greater and lesser toes was administered, including repression of relapse in deformity (D), pain reduction (P), improvement in shoe wearing (S), barefoot activity (B), and appearance (A). Overall satisfaction were assessed using the 5-digit-scale. Hallux valgus angle, 1, 2 intermetatarsal angle, and other radiologic parameters were measured. Pearson's correlation and multiple linear regression analyses were used to evaluate the relationships between these factors and overall satisfaction. Results Overall satisfaction was 4.0±0.82. Postoperative radiologic parameters were corrected in adequate range. Visual analog scale (VAS) was reduced from 7.2±2.1 to 2.2±1.8. For the greater toe, patient's expectations (D, P, S, B, and A) were 4.2, 4.1, 3.0, 2.5, 2.7 and satisfactions were 4.2, 4.0, 3.4, 3.5, 3.3, respectively. For the lesser toes, patient's expectations (D, P, S, B, and A) were 3.9, 4.1, 3.4, 3.0, 2.8, and satisfactions were 3.4, 4.0, 3.4, 3.6, 2.9, respectively. Satisfactions with P and B, and reduction amounts of VAS were significantly correlated with overall satisfaction. Conclusion Although forefoot reconstruction with a joint sacrificing procedure is non-physiological, it could be a good surgical option for severe RFD. Each patient's expectations and satisfactions with this procedure could vary. Thus, it seems important to inform patients preoperatively that expectation could be fulfilled well or less.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Young-Woon Gil
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Il-Hoon Sung
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Reinoso-Cobo A, Ortega-Avila AB, Ramos-Petersen L, García-Campos J, Banwell G, Gijon-Nogueron G, Lopezosa-Reca E. Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010147. [PMID: 36676771 PMCID: PMC9864291 DOI: 10.3390/medicina59010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.
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Affiliation(s)
- Andres Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Malaga, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Correspondence:
| | - Jonatan García-Campos
- Department of Behavioural Sciences and Health, University of Miguel Hernandez, 03202 Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - George Banwell
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Malaga, Spain
| | - Eva Lopezosa-Reca
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
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Cöster MC, Cöster A, Svensson F, Callréus M, Montgomery F. Swefoot - The Swedish national quality register for foot and ankle surgery. Foot Ankle Surg 2022; 28:1404-1410. [PMID: 35933290 DOI: 10.1016/j.fas.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Population-based register data could be used to improve our knowledge of patients surgically treated for foot and ankle disorders. The quality register Swefoot was recently created to collect surgical and patient-reported data of foot and ankle surgery. This manuscript aims to describe the development and current use of the register. METHODS The development of Swefoot started in 2014 and currently, data on 16 different diagnoses are collected in 49 units performing foot and ankle surgery. Registrations are performed by the surgeon and the patient. RESULTS Between 2014 and 2020 approximately 20,000 surgical procedures have been registered. 75.1% of the registered patients were women, 9.3% were smokers, 9.3% had a concomitant rheumatoid disease, and 18.4% a BMI larger than 30 kg/m2. CONCLUSIONS: The Swefoot is a unique national register for foot and ankle surgery. It is by now possible to present demographic, surgical, and outcome parameters based on Swefoot.
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Affiliation(s)
- Maria C Cöster
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden; Center of Registers Västra Götaland, Sweden; Uppsala University Hospital, Sweden; Skåne University Hospital, Sweden.
| | | | - Fredrik Svensson
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden; Skåne University Hospital, Sweden
| | - Mattias Callréus
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden; Skåne University Hospital, Sweden
| | - Fredrik Montgomery
- Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital Malmö, Sweden
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Yano K, Ikari K, Inoue E, Sakuma Y, Mochizuki T, Koenuma N, Tobimatsu H, Tanaka E, Taniguchi A, Okazaki K, Yamanaka H. Features of patients with rheumatoid arthritis whose debut joint is a foot or ankle joint: A 5,479-case study from the IORRA cohort. PLoS One 2018; 13:e0202427. [PMID: 30188930 PMCID: PMC6126825 DOI: 10.1371/journal.pone.0202427] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Foot and ankle joint disorders are serious issues for patients with rheumatoid arthritis (RA). We compared the differences between patients with RA whose first symptom involved a foot or ankle joint (FOOT group) versus other joints (non-FOOT group) within the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort in our institute. Patients and methods In the IORRA survey conducted in April 2016, patients were invited to complete six questionnaires about their first symptom at RA onset, current foot or ankle symptoms, daily living activities, and mental health. Disease activity, clinical laboratory variables, functional disability, quality of life, use and ratio of anti-inflammatory and antirheumatic drugs, daily living activities and mental health were compared between the two groups. Results Among 5,637 Japanese patients with RA who participated in the IORRA survey on April 2016, 5,479 (97.2%) responded to the questionnaire regarding their debut joint. Of these patients, 2,402 (43.8%) reported that their first symptom of RA involved a foot or ankle joint. The FOOT group (n = 2,164) had higher disease activity, higher disabilities, lower quality of life, lower activities of daily living, and poorer mental health and used anti-inflammatory drugs at a higher rate and at higher doses compared with the non-FOOT group (n = 2,164). On the other hand, the use of medications to suppress the disease activity of RA was similar between the groups. Conclusion Clinicians should pay more attention to foot and ankle joints in daily practice so as not to underestimate the disease activity of RA.
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Affiliation(s)
- Koichiro Yano
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- * E-mail:
| | - Eisuke Inoue
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yu Sakuma
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Takeshi Mochizuki
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Kamagaya General Hospital, Kamagaya, Chiba, Japan
| | - Naoko Koenuma
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Haruki Tobimatsu
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Eiichi Tanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Ken Okazaki
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Orthopedic surgery, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
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Mehasseb DF, Korayem HK, Tayel MY, Afifi AH, El-Tawab SS, Ibrahim AM. Pattern of forefoot bursae in patients with rheumatoid arthritis and its effect on foot functions. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_24_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhou L, Wang G, Liu X, Song J, Chen L, Xu H. Matrix metalloproteinase-3 and the 7-joint ultrasound score in the assessment of disease activity and therapeutic efficacy in patients with moderate to severe rheumatoid arthritis. Arthritis Res Ther 2017; 19:250. [PMID: 29141665 PMCID: PMC5688630 DOI: 10.1186/s13075-017-1449-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to investigate the reliability and validity of serum matrix metalloproteinase-3 (MMP-3) levels and articular ultrasound (US) scores in assessing disease activity and therapeutic response in rheumatoid arthritis (RA) patients. Methods A total of 151 RA patients were enrolled, of whom 22 were treated with certolizumab pegol (Cimzia, CZP). The RA patients were divided into the following four subgroups according to their disease activity score in 28 joints (DAS28): stable, mild activity, moderate activity, and high activity. Forty-three healthy controls were simultaneously studied. The serum MMP-3 levels and 7-joint US (US7) scores of all subjects were determined. The patients who were treated with CZP were subsequently followed for 6 months. Results The serum MMP-3 levels of all the RA patients were significantly higher than those of healthy controls, and those of patients with moderate and severe RA were significantly higher than those of patients with stable RA. The US7 scores of patients with severe RA were significantly higher than those of patients in other groups. Using the DAS28 as a reference standard, the corresponding cutoff value of MMP-3 was 70.5 ng/ml. After CZP treatment, the MMP-3 levels and US7 scores were significantly decreased at week 2, and the mean changes in US7 scores at weeks 12 and 24 were significantly higher in both groups with American College of Rheumatology 50% positive response (ACR50) and ACR 70% positive response (ACR70) than in the negative groups. Conclusion Serum MMP-3 and the US7 scores could both effectively reflect disease activity and therapeutic responses in patients with moderate to severe RA. Trial registration CTR20140405 (RA0044), CTR20140405: A phase 3, Multicenter, Double-blind, Placebo Controlled, Parallel Group, Randomized, 24-Week Study to Evaluate the Safety and Efficacy of Certolizumab Pegol as Additional Medication to Methotrexate in Chinese Subjects With Active Rheumatoid Arthritis Who Have an Incomplete Response to Methotrexate, Registered on 13 June 2014. CTR20140412 (RA0078), CTR20140412: A phase 3, Multicenter, Open-label Extension Study to Assess the Safety and Efficacy of Certolizumab Pegol as Additional Medication to Methotrexate in Chinese Subjects With Active Rheumatoid Arthritis Who Participated in RA0044, Registered on 02 July 2014.
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Affiliation(s)
- Ling Zhou
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Geng Wang
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Liu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jing Song
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Ling Chen
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Huji Xu
- Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Wang CC, Lee SH, Lin HY, Liu FW, Chiou HJ, Chan RC, Chou CL. Short-term effect of ultrasound-guided low-molecular-weight hyaluronic acid injection on clinical outcomes and imaging changes in patients with rheumatoid arthritis of the ankle and foot joints. A randomized controlled pilot trial. Mod Rheumatol 2017; 27:973-980. [DOI: 10.1080/14397595.2016.1270496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Si-Huei Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Wei Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veteran General Hospital Puli Branch, Nantou, Taiwan
| | - Hong-Jen Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Rai-Chi Chan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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El-Hewala AESI, Soliman SG, Labeeb AA, Zytoon AA, El-Shanawany AT. Foot neuropathy in rheumatoid arthritis patients: clinical, electrophysiological, and ultrasound studies. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.189640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gatt A, Formosa C, Otter S. Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis. Foot (Edinb) 2016; 27:27-31. [PMID: 27107307 DOI: 10.1016/j.foot.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/29/2016] [Accepted: 03/15/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND This pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement. METHODS Participants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses. RESULTS Nine female participants (mean age 52.2years (SD 9.1); mean weight 71kg (SD 12.64); mean height 160cm (SD 5.18)) with a mean RA duration of 11.7years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p=0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score. CONCLUSION Both Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.
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Affiliation(s)
- Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida 2080, Malta.
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida 2080, Malta
| | - Simon Otter
- School of Health Science, University of Brighton, 49 Darley Road, Eastbourne BN20 7UR, United Kingdom.
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Abstract
The frequency and extent of rheumatic forefoot deformities have been greatly reduced since the introduction of disease-modifying antirheumatic drugs (DMARD). The accompanying reduction in arthritic destruction of joints opens up new treatment options whereby priority is given to joint preservation. This is true for the first middle foot ray as well as for the small toe rays. Whereas resection arthroplasty of the metatarsophalangeal joints II-V was previously considered the gold standard treatment, joint-preserving operative procedures (e.g. metatarsal osteotomy and periarticular soft tissue interventions) are now being increasingly more propagated. Resection arthroplasty of the first midfoot ray has major biomechanical disadvantages so that it is not surprising that reconstructive procedures are given priority. In patients with severe arthritic destruction of the first metatarsophalangeal joint, arthrodesis has substantial biomechanical advantages compared to resection arthroplasty. Nevertheless, it has not yet been confirmed that fusion leads to superior clinical results.
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Yamada S, Hirao M, Tsuboi H, Akita S, Matsushita M, Ohshima S, Saeki Y, Hashimoto J. Involvement of valgus hindfoot deformity in hallux valgus deformity in rheumatoid arthritis. Mod Rheumatol 2014; 24:851-4. [PMID: 24533550 DOI: 10.3109/14397595.2013.874738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The involvement of valgus hindfoot deformity in hallux valgus deformity was confirmed in a rheumatoid arthritis case with a destructive valgus hindfoot deformity. Correction of severe valgus, calcaneal lateral offset, and pronated foot deformity instantly normalized hallux valgus deformities postoperatively. Thus, careful hindfoot status evaluation is important when assessing forefoot deformity, including hallux valgus, in rheumatoid arthritis cases.
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Affiliation(s)
- Shutaro Yamada
- Department of Orthopaedics, National Hospital Organization, Osaka Minami Medical Center , Osaka , Japan
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Louwerens JWK, Schrier JCM. Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options. INTERNATIONAL ORTHOPAEDICS 2013; 37:1719-29. [PMID: 23892468 PMCID: PMC3764283 DOI: 10.1007/s00264-013-2014-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Jan Willem K Louwerens
- Department of Orthopaedic Surgery, Foot and Ankle Reconstruction Unit, St Maartenskliniek, Nijmegen, The Netherlands.
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13
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Yamada S, Hirao M, Tsuboi H, Akita S, Matsushita M, Ohshima S, Saeki Y, Hashimoto J. Involvement of valgus hindfoot deformity in hallux valgus deformity in rheumatoid arthritis. Mod Rheumatol 2013. [PMID: 23359008 DOI: 10.1007/s10165-013-0835-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/11/2013] [Indexed: 11/27/2022]
Abstract
The involvement of valgus hindfoot deformity in hallux valgus deformity was confirmed in a rheumatoid arthritis case with a destructive valgus hindfoot deformity. Correction of severe valgus, calcaneal lateral offset, and pronated foot deformity instantly normalized hallux valgus deformities postoperatively. Thus, careful hindfoot status evaluation is important when assessing forefoot deformity, including hallux valgus, in rheumatoid arthritis cases.
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Affiliation(s)
- Shutaro Yamada
- Department of Orthopaedics, National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
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