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Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options.

Authors
Type
Published Article
Journal
International Orthopaedics
1432-5195
Publisher
Springer-Verlag
Publication Date
Volume
37
Issue
9
Pages
1719–1729
Identifiers
DOI: 10.1007/s00264-013-2014-2
PMID: 23892468
Source
Medline

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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