Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

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.

Quality of life impact related to foot health in a sample of sea workers

“…However, based on the results of the few studies carried out on this matter [16,17], the impact of the quality of life related to foot health is not as obvious as it appears to be, whereas the results of the present study confirm that people who work at sea present lower scores on the dimensions related to foot pain, foot function, general foot health and social function, than people who work on the ground with normalised reference values. Taking into account these results, it seems necessary to point out the importance of the care and control of the foot in what regards medical and podiatric care in order to prevent the appearance of illnesses and deformities of the foot, this being a key aspect that would allow to improve sea workers' health, quality of life and autonomy.…”

The foot function index is more sensitive to change than the Leeds Foot Impact Scale for evaluating rheumatoid arthritis patients after forefoot or hindfoot reconstruction

“…Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment [1]. The foot is most commonly affected early with a prevalence of up to 90 % for the metatarsophalangeal (MTP) joints and in 15 % the forefoot is the first manifestation of the disease [2].…”

Plantar Plate Pathology: A Review Article

“…The etiology of plantar plate pathology is multifactorial [9][10][11][12]. Any biomechanical abnormality leading to overload of the lesser metatarsals may result in plantar plate deterioration and subsequent MTPJ instability; this includes a long second metatarsal, first ray hypermobility, hallux abducto valgus, hallux rigidus, and pes planus [4,9].…”

“…Changes of the biomechanical axes of the primary flexors of the lesser MTPJs (the interosseous muscles) in addition to the lumbricals, flexor digitorum brevis, and flexor digitorum longus result in a defective restraint to prevent dorsal subluxation of the toe [10]. The chronic inflammatory state of synovial tissues in rheumatoid arthritis and other systemic arthritic diseases causes soft tissue and bone destruction which progresses to joint insufficiency and often frank dislocation of the lesser MTPJs [11]. Less commonly, acute trauma produces this condition [12].…”