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Okamura G, Hirao M, Noguchi T, Etani Y, Ebina K, Kurihara T, Goshima A, Tsuboi H, Tsuji S, Takami K, Okada S, Hashimoto J. Flatfoot Surgery for Flexible Progressive Collapsing Foot Deformity With Inflammatory Joint Diseases: A Report of 3 Cases. JBJS Case Connect 2024; 14:01709767-202409000-00022. [PMID: 39088657 DOI: 10.2106/jbjs.cc.23.00673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
CASE Three cases of inflammatory joint diseases (systemic lupus erythematosus and ongoing juvenile idiopathic arthritis) with painful flexible progressive collapsing foot deformity (PCFD) underwent flatfoot surgery. All cases maintained sufficient radiological correction and achieved good clinical condition at final follow-up. CONCLUSION Although the prospect for recurrence of the deformity is not clear, even in inflammatory joint diseases, flat foot surgery such as flexor digitorum longs transfer, spring ligament reconstruction, and lateral column lengthening could have a possibility to be indicated against PCFD, as long as disease activity could be well suppressed by drug therapy, subsequently subtalar and talonavicular joints could be preserved.
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Affiliation(s)
- Gensuke Okamura
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano City, Osaka, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano City, Osaka, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita City, Osaka, Japan
| | - Yuki Etani
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita City, Osaka, Japan
| | - Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita City, Osaka, Japan
| | - Takuya Kurihara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita City, Osaka, Japan
| | - Atsushi Goshima
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai City, Osaka, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai City, Osaka, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedic Surgery, Nippon Life Hospital, Osaka City, Japan
| | - Kenji Takami
- Department of Orthopaedic Surgery, Nippon Life Hospital, Osaka City, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita City, Osaka, Japan
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano City, Osaka, Japan
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2
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Tominaga A, Ikari K, Yamada A, Yano K, Okazaki K. Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis. Foot Ankle Int 2024; 45:261-271. [PMID: 38327241 DOI: 10.1177/10711007241226898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction. METHODS This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit. RESULTS The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups. CONCLUSION In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Ayako Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | - Akifumi Yamada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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3
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Yano K, Ikari K, Shiraki E, Midorikawa M, Maeda M, Kubo K, Kuwahara Y, Okazaki K. Short-term efficacy and limitations of foot care in patients with rheumatoid arthritis. Mod Rheumatol 2024:roae012. [PMID: 38430527 DOI: 10.1093/mr/roae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 03/04/2024]
Abstract
OBJECTIVES Foot and ankle impairments are major issues in patients with rheumatoid arthritis (RA). Foot deformities often lead to skin disorders, such as callosities, ingrown toenails, and interdigital tinea pedis. This study was aimed at investigating the efficacy and limitations of foot care by experts in patients with RA. METHODS Thirty-one patients with RA who began receiving foot care from nurses at our institution between September 2020 and February 2023 were included. Responses to a survey using the self-administered foot evaluation questionnaire (SAFE-Q) for patient-reported outcome measures were compared at baseline, the second visit (1.3 ± 0.5 months after baseline), and the third visit (3.6 ± 1.6 months after baseline). RESULTS Scores for 'Pain and pain-related' and 'General health and well-being' components of SAFE-Q markedly improved after foot care. On the other hand, there were no significant differences in the scores for 'Physical functioning and daily living', 'Social functioning', and 'Shoe-related' components during observation periods. CONCLUSIONS Foot care for rheumatoid feet is effective in providing pain relief and improving general health and well-being. However, physical and social functioning and footwear issues did not improve. Clinicians must understand the effects and limitations of foot care in patients with RA.
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Affiliation(s)
- Koichiro Yano
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Foot Clinic Omotesando, Tokyo, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
- Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | | | | | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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4
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Mikami Y, Yamaguchi S, Teramoto A, Amaha K, Yasui T, Kurashige T, Nagashima R, Endo J, Takakura Y, Noguchi K, Sadamasu A, Kimura S. Impact of pain in other body regions on the foot-specific quality of life in patients with hallux valgus. Mod Rheumatol 2023; 33:428-433. [PMID: 35106594 DOI: 10.1093/mr/roac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/12/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus. METHODS Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOLwas assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses. RESULTS Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. CONCLUSION More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain.
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Affiliation(s)
- Yukio Mikami
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.,Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University, Hokkaido, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Toshinori Kurashige
- Department of Orthopaedic Surgery, Chiba Aiyukai Memorial Hospital, Chiba, Japan
| | | | - Jun Endo
- Department of Orthopaedic Surgery, Yoh memorial Hospital, Chiba, Japan
| | | | - Koji Noguchi
- Department of Orthopaedic Surgery, Kurume General Hospital, Fukuoka, Japan
| | - Aya Sadamasu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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5
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Tobimatsu H, Ikari K, Yano K, Okazaki K. Radiographic factors associated with painful callosities after forefoot surgery in patients with rheumatoid arthritis. Mod Rheumatol 2023; 33:104-110. [PMID: 34939107 DOI: 10.1093/mr/roab131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Operative procedures for rheumatoid forefoot deformities have gradually changed from arthrodesis or resection arthroplasty to joint-preserving surgery. Although joint-preserving arthroplasty has yielded good outcomes, painful plantar callosities may occur post-operatively. This study aimed to reveal the radiographic factors associated with painful callosities after joint-preserving surgery for forefoot deformities in patients with rheumatoid arthritis (RA). METHODS We retrospectively evaluated 166 feet in 133 patients with RA who underwent forefoot joint-preserving arthroplasty, including proximal rotational closing-wedge osteotomies of the first metatarsal, between January 2012 and December 2015. Logistic regression analysis was performed with the objective variable set as the presence/absence of painful plantar callosities at the final observation and the explanatory variables set as several radiographic factors, including post-operative relative first metatarsal length (RML), amount of dorsal dislocation of the fifth metatarsal (5DD), and arc failure of the lesser toes. RESULTS At the final follow-up, 42 of the 166 feet (25.3%) had painful callosities under the metatarsal heads post-operatively. Logistic regression analysis showed that the RML, 5DD, and lesser toes' arc failure were significantly associated with painful callosities. CONCLUSIONS We identified that RML, 5DD, and arc failure of the lesser toes were associated with painful plantar callosities after the surgery.
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Affiliation(s)
- Haruki Tobimatsu
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Katsunori Ikari
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan.,Division of Multidisciplinary Management of Rheumatic Diseases, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Koichiro Yano
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan.,Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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6
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Hassel K. Unterschiede in der Therapie entzündlich rheumatischer und
degenerativer Füße. Die Vorfußchirurgie. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1814-4096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDer Unterschied zwischen rheumatischen und degenerativen Veränderungen am
Fuß liegt in der fortschreitenden Destruktion der Gelenke bei
persistierender Synovialitis der rheumatoiden Arthritis (RA). Unter der heute
wirksameren immunsuppressiven Therapie und eines frühen und aggressiven
Beginns zeigen sich mildere Verlaufsformen. So können zunehmend auch
gelenkerhaltende Verfahren der Vorfußchirurgie Anwendung finden.
Entscheidend ist hier jedoch die Remission mit sicherer Krankheitskontrolle
für den gelenkerhaltenden Eingriff. Dennoch ist das Rezidiv- und
Fehlstellungsrisiko aufgrund wiederkehrender arthritischer Phasen höher.
Rheumaorthopädische Standardverfahren, wie die Arthrodese des
Großzehengrundgelenkes mit Resektion der Metatarsaleköpfchen
haben aber Ihren Stellenwert beim Vollbild des erosiven rheumatischen
Vorfußes nicht verloren. Ein standardisiertes Vorgehen fehlt. Umso
wichtiger ist es, mit jedem Patienten individuell die richtigen
Maßnahmen zu festzulegen.
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Affiliation(s)
- Kathryn Hassel
- Orthopädische Rheumatologie, Vitos Orthopadische Klinik Kassel
gGmbH, Kassel, Germany
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Hembree WC, Gallagher BW, Guyton GP. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2022; 104:857-863. [PMID: 35316249 DOI: 10.2106/jbjs.21.01562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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8
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Nomura Y, Ishikawa H, Abe A, Otani H, Ito S, Kaji Y, Yamamoto T, Nakazono K, Murasawa A. More than 20 years' follow-up of metatarsal neck shortening oblique osteotomy for rheumatoid forefoot deformity. J Orthop Sci 2022; 28:607-613. [PMID: 35396140 DOI: 10.1016/j.jos.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND In recent years, advances in pharmacotherapy for rheumatoid arthritis (RA) have dramatically improved the control of disease activity. However, a significant number of patients still develop forefoot deformity. The purpose of this study was to investigate the results of more than 20 years' follow-up of metatarsal neck shortening oblique osteotomy (SOO) for forefoot deformity in patients with RA. METHODS The metatarsal neck SOO was performed on 163 feet in 108 patients between January 1985 and December 1996 in the authors' hospital. For the patients, who met the survey criteria, an observational study was performed clinically and radiologically at the baseline and at more than 20 years after surgery. RESULTS A retrospective cohort study was conducted on 36 feet in 22 patients, all of whom were female, and the mean age at surgery was 45.6 (35.0-63.0) years old. The follow-up period was 25.1 (21.0-31.0) years. The presence of painful callosities in the surgically treated feet without revised surgeries decreased from 32 feet (100%) to 4 feet (12.5%) at the last follow-up with mild pain that did not cause any footwear problems. Re-osteotomy at the metatarsal of the lessor toe was performed on four feet in two patients. Radiologically, among 128 toes without revised surgeries, 85% were able to have the joint space preserved, and 89% maintained a pain-free condition without any recurrence of deformity. The mean total Japanese Society for Surgery for the Foot (JSSF) RA foot and ankle score was 64.0/100, and the visual analogue scale (VAS) of overall satisfaction was 62 (0: dissatisfied, 100: highly satisfied). The overall satisfaction had a positive correlation with calcaneal pitch and negative correlation with joint space narrowing at the talocrural joint. CONCLUSIONS Metatarsal neck SOO appeared to be effective for patients with RA. The deformity was corrected and retained for a long time.
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Affiliation(s)
- Yumi Nomura
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho, Kita-gun, Kagawa 761-0701, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan.
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho, Kita-gun, Kagawa 761-0701, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho, Kita-gun, Kagawa 761-0701, Japan
| | - Yoshio Kaji
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho, Kita-gun, Kagawa 761-0701, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-cho, Kita-gun, Kagawa 761-0701, Japan
| | - Kiyoshi Nakazono
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan
| | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8, Honcho, Shibata City, Niigata 957-0054, Japan
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9
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Takakubo Y, Wanezaki Y, Oki H, Naganuma Y, Shibuya J, Honma R, Suzuki A, Satake H, Takagi M. Forefoot Deformities in Patients with Rheumatoid Arthritis: Mid- to Long-Term Result of Joint-Preserving Surgery in Comparison with Resection Arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111257. [PMID: 34769775 PMCID: PMC8583379 DOI: 10.3390/ijerph182111257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Abstract
Background: Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot. Methods: Forefoot surgeries were performed on 62 toes in 42 patients with RA (men: 2; women: 40) between 2002 and 2018. Three groups were compared: PP—31 toes treated with joint-preserving surgery involving the modified Mann method for the big toe and offset osteotomy for lesser toes, PR—15 toes treated with joint-preserving surgery for the big toe and resection arthroplasty for lesser toes, and RR—16 toes treated with resection arthroplasty for all the toes. Results: The PP group had significantly higher mean scores on a scale for RA in the foot and ankle at the latest follow-up than the RR group (86 vs. 75 points; p < 0.05). Hallux valgus (angle > 20°) of the big toe at the latest follow-up recurred in 10 (32%), 9 (60%), and 16 (100%) patients in the PP, PR, and RR groups, respectively. A revision surgery was performed in one patient each in the PP and PR groups. Conclusions: Joint-preserving surgery is superior to resection arthroplasty in preventing function loss and the recurrence of hallux valgus.
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Affiliation(s)
- Yuya Takakubo
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Department of Rehabilitation, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
- Correspondence:
| | - Yoshihiro Wanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
| | - Hiroharu Oki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Faculty of Orthopaedic Surgery, Yamagata Saisei Hospital, Yamagata 990-9585, Japan
| | - Yasushi Naganuma
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Faculty of Orthopaedic Surgery, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan
| | - Junichiro Shibuya
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Department of Orthopaedic Surgery, Izumi Orthopaedic Hospital, Sendai-shi 981-3121, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
- Department of Rehabilitation, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Akemi Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan; (Y.W.); (H.O.); (Y.N.); (J.S.); (R.H.); (A.S.); (H.S.); (M.T.)
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10
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Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010667. [PMID: 34682415 PMCID: PMC8535323 DOI: 10.3390/ijerph182010667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/09/2021] [Indexed: 02/08/2023]
Abstract
Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.
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11
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Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910473. [PMID: 34639772 PMCID: PMC8508223 DOI: 10.3390/ijerph181910473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 11/17/2022]
Abstract
With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.
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Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084093. [PMID: 33924481 PMCID: PMC8068870 DOI: 10.3390/ijerph18084093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
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