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Reconstructive foot surgery.

In rheumatoid arthritis (RA) we find a high rate of foot involvements, especially in progressive cases when we see patients submitted for hospital treatment. In about 50% of these patients the ankle joints are involved (25), in juvenile RA even in two thirds of all cases. More than half of all progressive cases show also joint affections of the forefoot. Mainly the metatarsophalangeal joints are involved, especially the first MTP joint. We also can find a high involvement rate of the interphalangeal joint of the big toe. In RA the peripheral toe joints II-V are less frequently involved. Changes in these joints are very much likely to be caused by other inflammatory rheumatic diseases. Even more often than in the ankle joints we can find changes in the tarsal joints, as well as in the tarsometatarsal joints. As we know, in RA the incidence of surgery does not refer to the affection rate. The indication for surgery depends mainly on the amount of functional disability, pain, and the efficacy of conservative treatment. The need of these therapies can differ very much in various countries. E.g. in the Rheumatism Foundation Hospital, Heinola more than one third of all operations were foot surgery, whereas in our clinic, organised in a very similar way to Heinola, we have "only" 20%. Apart from tenosynovectomies and synovectomies at the ankle joint, the operations are nearly exclusively of reconstructive character.