Surgical Treatment for Rheumatoid Forefoot Deformities by Complete Resection Arthroplasty of the Lesser Metatarsophalangeal Joints and Partial Syndactylization.

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Five patients (eight feet) with deformities of the rheumatoid forefoot were treated with complete resection arthroplasties of the lesser (2nd to 5th) metatarsophalangeal (MTP) joints and partial syndactylizations. The mean Lansbury Articular Index of the patients was 41% (range: 35 to 49%) . The surgical results were evaluated on the 100-point forefoot score, and the recurrence of the dislocations of MTP joints and painful calluses were examined. At the time of the most recent follow-up, the mean value of the score had increased significantly from 24 points (range: 8 to 55 points) preoperatively to 70 points (range: 50 to 85 points) thirty days postoperatively (p<0.05) . The value further increased to 73 points (range: 50 to 88 points) . A callus recurred in one patient, but the size was smaller than that of the preoperative one. No recurrence of dislocation at the lesser MTP joints was found during the follow-up period.<BR>We conclude that this procedure is suitable as an arthroplasty for treatment of rheumatoid forefoot deformities. To ensure the efficacy of the procedure, however, it is necessary that the patient's arthritis is kept under good control, and that good congruity of the lesser MTP joints is maintained for at least two years postoperatively, and recurrences of painful calluses are prevented.
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