Resection of the Metatarsophalangeal Joints in Rheumatoid Arthritis

Brattström, H; Brattström, M

doi:10.3109/17453677008991508

Cited by 32 publications

(13 citation statements)

References 5 publications

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“…Excision of individual symptomatic heads leads to transfer metatarsalgia and thus to worse results than excision of all four and to more operations [19,36,43]. Others have concomitantly excised the base of the proximal phalanges [17, 18, 20-22, 31-33, 44-47].…”

Section: Resection Of the Mt Headsmentioning

confidence: 99%

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Louwerens¹,

Schrier

2013

International Orthopaedics (SICOT)

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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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Section: Resection Of the Mt Headsmentioning

confidence: 99%

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Louwerens¹,

Schrier

2013

International Orthopaedics (SICOT)

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“…Overall outcome varied from excellent or good in 60 -85% (32,34), good in 75% (38), good or satisfactory in 88% (39), and fair or good in 93% (41) of cases. Satisfaction with the operative procedure varied between 25% and 67% (36,37,43).…”

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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“…Although the results are reported to be rather satisfactory, the foot becomes shorter, and the toes are functionally detached which in turn affects walking ability [44,49]. There is also a risk of relapse of hallux valgus due to poor lateral support from the other toes, which may be an argument for arthrodesis in the metatarsophalangeal joint of the great toe [3].…”

Section: Indications and Surgical Methodsmentioning

confidence: 99%

“…Resection of the first MTP joint offers pain relief, but poor function of the great toe, decreased ability to bear weight on the medial forefoot, poorer balance, and a significant risk of hallux valgus relapse with the risk for lateralization of the small toes [2,3,37,44]. In this respect, arthrodesis seems preferable [19,36].…”

Section: Forefootmentioning

confidence: 99%

The foot

2000

Acta Orthopaedica Scandinavica

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Resection of the Metatarsophalangeal Joints in Rheumatoid Arthritis

Cited by 32 publications

References 5 publications

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

Interventions for foot disease in rheumatoid arthritis: A systematic review

The foot

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