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[Rheumatoid forefoot reconstruction with first metatarsophalangeal fusion and arthroplasty of lesser metatarsal heads].

OBJECTIVE
To evaluate the surgical treatment and effectiveness of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads.


METHODS
Between January 2007 and August 2009, 7 patients with rheumatoid forefoot were treated by reconstruction with arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads. They were all females with an average age of 62 years (range, 56-71 years) and with an average disease duration of 16 years (range, 5-30 years). All patients manifested hallux valgus, hammer toe or mallet toe of 2-5 toes, 5 feet complicated by subluxation of the second metatarsophalangeal joint. The improved American Orthopaedic Foot & Ankle Society (AOFAS) score was 36.9 +/- 6.4. The hallux valgus angle was (46 +/- 5) degrees, and the intermetarsal angle was (12 +/- 2) degrees by measuring the load bearing X-ray films preoperatively.


RESULTS
All incisions healed by first intention after operation. The X-ray films showed bone fusion of the first metatarsophalangeal joint at 3-4 months after operation. Seven patients were followed up 2.9 years on average (range, 2-4 years), gait was improved and pain was relieved. The hallux valgus angle decreased to (17 +/- 4) degrees and the intermetarsal angle was (11 +/- 2) degrees at 3 months postoperatively, showing significant differences when compared with preoperative values (P < 0.05). The improved AOFAS score was 85.3 +/- 5.1 at 2 years postoperatively, showing significant difference when compared with preoperative score (t = 4.501, P = 0.001). One patient had recurrent metatarsalgia at 4 years after operation.


CONCLUSION
Arthrodesis of the first metatarsophalangeal joint and arthroplasty of lesser metatarsal heads for rheumatoid forefoot reconstruction can correct hallux valgus, remodel the bearing surface of the forefoot, and relieve pain, so it can be considered as a procedure that provides improvement in the clinical outcome.