[Correction of rheumatic forefoot. The value of a combined arthrodesis of the first toe and resection of metatarsal heads 2-5].
BACKGROUND
Resection of the metatarsal heads is an established procedure for the therapy of rheumatic forefoot deformations. However, a recurrence of lateral deviation of the lesser toes and painful plantar keratosis remain a challenging problem for the treatment of these patients. The aim of this study was to evaluate our results in cases of rheumatoid forefoot deformities. We performed a resection of the metatarsal heads 2-5 in combination with an arthrodesis of the first toe and resection of keratosis by the plantar approach.


METHODS
Fifteen patients (20 feet) were followed-up clinically and radiologically using the American Orthopedic Foot and Ankle Society (AOFAS), Miehlke-, and Larsen scores.


RESULTS
Average follow-up time was 3.5 years (range: 1.5-7.5 years). An average AOFAS score of 81/90 was found for the hallux and 90/100 for the lesser toes. A total of 18 feet were rated as pain free, while two feet showed some residual pain. Every case showed an harmonic cascade of the resection. All patients stated that the operation had improved their quality of life and that they would consent to undergoing it again.


CONCLUSIONS
Our results after arthrodesis of MP-1 and resection of the metatarsal heads 2-5 using the plantar approach were good compared to the data published in the literature.
Heitkemper
S
S
Orthopädische Universitätsklinik Essen, Hufelandstrasse 55, 45147, Essen. heitkemper@gmx.de
Pingsman
A
A
Quitmann
A
A
Patsalis
T
T
D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D014034:Toes / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome