Foot Pressure Studies in the Assessment of Forefoot Arthroplasty in the Rheumatoid Foot

Betts, R. P.; Stockley, I; Getty, C.J.M.; Rowley, D.I.; Duckworth, T.; Franks, C. I.

doi:10.1177/107110078800800607

Cited by 24 publications

(8 citation statements)

References 18 publications

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“…These results have been confirmed by several authors [2,20,21]. As a result Tillmann [22] suggested that Keller's operation should not be combined with a metatarsal head resection of the lesser toes.…”

Section: Discussionsupporting

confidence: 75%

The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis

2001

International Orthopaedics (SICOT)

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We performed a retrospective study in 188 patients (254 feet) with rheumatoid arthritis and compared the late results of Keller's procedure with those of Hueter-Mayo's technique after 7.9 years. More than 60% of the Keller group and 30% of the HueterMayo group were suffering from persistent metatarsalgia due to increased forefoot pressure as well as experiencing pain around the great toe. Plantar callosities, recurrent hallux valgus deformity, lack of plantar flexion and weakened push-off were more frequent after Keller's procedure.Résumé Nous présentons une étude rétrospective de 188 patients (254 pieds) atteints de polyarthrite rhumato et avons comparé le résultat de la technique de Keller avec celle de Hueter-Mayo après 7.9 années. Plus de 60% des patients du groupe Keller et 30% du groupe Hueter-Mayo a souffert de métatarsalgies persistantes dû à l'augmentation de la pression de l'avant-pied et de douleurs du premier orteil. Callosités plantaires, hallux valgus récurrent, manque de flexion plantaire et de force de poussée du premier orteil étaient plus fréquents après le procédé de Keller.

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Section: Discussionsupporting

confidence: 75%

The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis

2001

International Orthopaedics (SICOT)

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“…Seven reports of 4 prospective observational studies were identified. These evaluated minor surgery (plantar callous debridement) (25), intraarticular radiation to the ankle (26), forefoot arthroplasty involving the great toe (4 reports of the same patient group with different followup times and outcome measures) (27)(28)(29)(30), and first MTP joint silicone implantation (31). Almost all studies, apart from the study on intraarticular radiation, involved only the forefoot.…”

Section: Review Of Foot Disease Interventions In Ramentioning

confidence: 99%

“…Larger groups of patients, evaluated postoperatively, showed better clinical results; at a mean of 3 years after surgery, 91% of 35 patients were satisfied (29) and at a mean of 4 years, 89% of 28 patients were satisfied and 75% noted painless walking (28). A study examining static and dynamic foot pressures at a mean of 2 years after surgery (30) showed that such surgery led to a marked reduction of pressure under the central metatarsals.…”

mentioning

confidence: 99%

Interventions for foot disease in rheumatoid arthritis: A systematic review

2005

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Objective. To systematically review medical and surgical foot intervention studies in rheumatoid arthritis (RA), focusing on clinical efficacy, study quality, and risk of harm. Methods. We searched appropriate databases using a combination of the terms "rheumatoid arthritis" and "foot" against terms indicating treatment; we also hand-searched references. We selected articles in English (1968 -2003) comprising randomized controlled trials (RCTs), controlled clinical trials (CCTs), prospective observational studies, and large retrospective observational surgical studies (>50 cases). RCT quality was examined using Jadad scoring; other designs were assessed qualitatively. Results. Inclusion criteria were met by 33 of 894 identified studies, comprising 5 RCTs and 1 CCT (all nonsurgical), 15 prospective observational studies (8 nonsurgical, 7 surgical), and 12 large retrospective studies (all surgical). Functional, custom-designed and semirigid orthoses and extra-depth shoes were effective in single RCTs of variable quality; no comparative studies have been conducted. This finding was supported by a CCT and prospective observational studies. There was no evidence of harm. There were no controlled trials of surgery. Prospective observational studies suggest that forefoot arthroplasty and first metatarsophalangeal joint implants, but not plantar callous debridement, are effective. Comparative retrospective analyses suggest that some procedure variants may be better, and surgery may relieve pain better than orthoses. Infection was the main risk. Conclusion. RCT evidence shows that orthoses and special shoes are likely to be beneficial in patients with RA. The only evidence of benefit from surgery comes from observational studies, because no RCTs have been conducted. Further RCT evidence is needed, although well-designed observational studies may be helpful.

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“…Betts et al 4 and Stockley et al 4,21,24 presented quantitative data to show a reduction in plantar pressure during walking. This was under the middle forefoot regions (MTHs 2, 3, and 4) in a prospective study of 60 feet in patients with RA who had undergone a modified panmetatarsal head resection.…”

Section: Discussionmentioning

confidence: 99%

“…Several surgical techniques have been proposed to accomplish the presumed goal of metatarsal head load relief in such patients. 4,10–14,16,17 Results reported have mostly been subjective in nature. 1,3,8,26 It is notable that in one study 25 almost one third of the patients complained of pain and callosities at 5 years, which suggests that elevated plantar pressures continued to exist in those cases.…”

Section: Discussionmentioning

confidence: 99%

Elevated Plantar Pressure and Ulceration in Diabetic Patients After Panmetatarsal Head Resection: Two Case Reports

1999

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Panmetatarsal head resection (variously called forefoot arthroplasty, forefoot resection arthroplasty, the Hoffman procedure, and the Fowler procedure) was developed for the relief of pain and deformity in rheumatoid arthritis. Although there are successful retrospective series reported in the literature, such an approach is not supported by carefully designed controlled trials. This procedure has also been advocated by some for the relief of plantar pressure in diabetic patients who are at risk for plantar ulceration. The efficacy of the procedure in this context is not supported by existing pressure measurements on rheumatoid arthritis patients in the literature, which has tended to show that although pain relief is obtained, the procedure results in elevation of forefoot pressure. Case reports are described of two patients (three feet) with sensory neuropathy who presented to our clinic 1 to 2 years after panmetatarsal head resections had been performed. Peak plantar pressures in these feet during first step gait were above the 99th percentile and outside the measuring range of the device used (EMED SF platform; NOVEL Electronics Inc., St. Paul, MN). Both patients had also experienced plantar ulcers subsequent to the surgery. Combining the information on patients with rheumatoid arthritis (RA) with that from our two case studies, we conclude that panmetatarsal head resection does not necessarily eliminate focal regions of elevated plantar pressure.

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Foot Pressure Studies in the Assessment of Forefoot Arthroplasty in the Rheumatoid Foot

Cited by 24 publications

References 18 publications

The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis

The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis

Interventions for foot disease in rheumatoid arthritis: A systematic review

Elevated Plantar Pressure and Ulceration in Diabetic Patients After Panmetatarsal Head Resection: Two Case Reports

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