Operative Eingriffe an Fuß und Sprunggelenk

Abstract

Rheumatoid arthritis is a systemic disease that often affects the foot and ankle (85%-100% of patients). There are characteristic deformities in relation to the stage of disease. Clinical assessment of both lower limbs is important, since factors such as valgus deformity of the knee can cause malposition of the foot and ankle. In the early stages, patients present with joint effusion which causes destruction of the cartilage ("stiff type") and distends ligaments and capsules ("loose type"). Medial and lateral ankle tendons are destroyed and become insufficient. A reduction in walking distance, pain, instability and difficulties with footwear lead to reduced quality of life. The talonavicular joint and rheumatoid forefoot destruction are in most cases the central problem in the foot deformity. Adequate medical therapy of the rheumatic disease is mandatory. Conservative treatment such as orthotic shoe devices should be used in the early stages and are concomitantly used after surgical treatment. Rheumatoid arthritis is a systemic disease requiring careful, stage-specific perioperative management.

Rheumatoid Forefoot Reconstruction Following Minimally Invasive Surgery and Hoffmann-Clayton Procedure with Administration of Plasma Rich in Growth Factors - A 3-Year Follow-Up: A Retrospective Study

“…Three years of follow-up of forefoot reconstructions according to Hoffmann-Clayton and minimally invasive surgery with the administration of plasma rich in growth factors is a much-needed study. Though joint preserving surgery with improved anti-rheumatism medications serves to be successful these days, the joint sacrificing surgery of II to V toes remains to be the gold standard method in cases of severely damaged forefoot in rheumatoid patients (16,17). Hoffmann-Clayton's technique commonly uses a plantar approach.…”

Forefoot Reconstruction Following Metatarsal Head Resection Arthroplasty With a Plantar Approach—A 20-Year Follow-Up

“…Although joint protection and/or maintaining interventions are now more frequently successful after the introduction of DMARD therapy, the metatarsal head resection of the lesser toes II to V remains the gold standard therapy for the severely deformed rheumatoid forefoot. 22 In contrast to the Tillmann procedure, the Stainsby operation uses a dorsal approach with several longitudinal incisions. 27 Instead of resecting the metatarsal heads, the Stainsby operation resects the base of the proximal phalanges and repositions the dislocated plantar plate beneath the metatarsal heads.…”

Operative Rheumatologie des Vorfußes – ein Trend zu gelenkerhaltenden Eingriffen?

“…Wird der erste Mittelfußstrahl infolge einer Rückfußeversion und der Mittelfußabduktion übermäßig belastet, kann zusammen mit der Entstehung eines Metatarsus-primus-varus auch eine Instabilität des ersten Tarsometatarsalgelenk (TMT-I-Gelenk) mit supinatorischer Verdrehung des I. Strahls entstehen, welches in die klinische Untersuchung miteinbezogen werden muss. Eine Instabilität der medialen Säule und entzündliche Destruktion der Navikulokuneiformegelenke können die Deformität noch verstärken [15]. Die in den Lisfranc-Gelen-ken mobileren lateralen zwei Mittelfußstrahlen unterliegen einer gleichgerichteten medialen Abweichung.…”