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  1. R. Kurose1
  1. 1Hirosaki Memorial Hospital, Hirosaki, Japan


Background: Patients with rheumatoid arthritis (RA) have frequently painful foot deformities. These deformities including hallux valgus, dorsal dislocation of the metatarsophalangeal (MTP) joints and hammer toe deformity of the lesser toes are associated with disability in daily activities.

Objectives: The aim of this study is to investigate short and mid-term outcome of forefoot surgery for patients with RA.

Methods: We investigated 28 patients with 39 foots who underwent forefoot surgery between January 2010 and December 2018 and followed for more than one year after surgery. Swanson implant arthroplasty or metatarsal osteotomy was performed for big toe, and shortening oblique osteotomy (SOO) was performed for the II-V toes. Examination items were as follows; plain X-ray changes in the angle of hallux valgus (HVA), the angle between the first and second metatarsal bones (M1/2), and the angle between the first and fifth metatarsal bones (M1/5) after surgery. The progress of painful hyperkeratosis and bunion, Japanese Society for Surgery of the foot standard rating system (JSSF scale), the recurrence of deformity and bone fusion, complications, and patient satisfaction were also examined.

Results: The patients followed were 24 women with 34 feet and 4 men with 5 feet, and average age at the time of surgery was 66.1 years. HVA improved from average of 39.7 degrees to 20.2 degrees one month after surgery, but increased slightly to 23.5 degrees one year after surgery. Painful hyperkeratosis and bunion tended to disappear one month after surgery, and JSSF scale significantly improved at the final observation. One year after surgery, the bone fusion rate of big toe was 100%, but 7.8% of the metatarsal bone underwent SOO had non-union. The complications after surgery were one infection at the surgical site, one necrosis at the tip of the toe, and one infection of Swanson implant. Patient satisfaction at the final observation was high

Conclusion: Forefoot surgery for RA has problems such as recurrence, non-union, and infections, but it is considered to be a useful treatment because that pain by hyperkeratosis and bunion disappears and ADL improves.

References: [1]Sung IH, Sung YK, Huh DR, Kim SJ. A comparative study on the results of the modified Ludloff osteotomy for hallux valgus deformities with minimal erosion of the metatarsophalangeal joints in rheumatoid patients versus non-rheumatoid patients.. Mod Rheumatol 2015; 25(5): 694-700.

Disclosure of Interests: None declared

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