title: Preservation of lesser metatarsophalangeal joints in rheumatoid forefoot reconstruction.
abstract: BACKGROUND
  A standard rheumatoid forefoot reconstruction consists of arthrodesis of the first metatarsophalangeal (MTP) joint and resection arthroplasty of the lesser metatarsal heads. However, preservation of the metatarsal heads has gained renewed interest since the medical treatment of rheumatoid arthritis has improved dramatically.
  
  
  METHODS
  Nineteen consecutive patients with severe rheumatoid forefoot deformities underwent 24 forefoot reconstructions including first MTP arthrodesis with lesser MTP resection arthroplasty (resection arthroplasty group, ten feet), arthrolysis (arthrolysis group, six feet), or a combination of both (combined group, eight feet). Subjective, functional, and radiographic results were evaluated at 28 and 133 months (mean) followup.
  
  
  RESULTS
  The overall AOFAS Forefoot Score at short- and long-term followup improved significantly (all p < 0.0001). There were no substantial differences between groups with regard to subjective rating, function, use of orthopaedic aids or shoewear, and walking capacity. Radiographic evaluation revealed a significant increase in axial malalignment of the lesser toes at long-term followup in all groups (all p < 0.018). Sagittal malalignment increased substantially in the resection arthroplasty group only. Reoperation rate was comparable among all groups, and a single third MTP arthrolysis (3%, 1/40) was converted to resection arthroplasty.
  
  
  CONCLUSIONS
  In combination with first MTP arthrodesis, arthrolysis with preservation of all or only the lateral lesser MTP joints in rheumatoid forefoot reconstruction was a viable and durable alternative to resection arthroplasty when the joint destruction was mild to moderate.
authors.affiliation: Department of Orthopaedic Surgery, University of Bern, Switzerland.
authors.forename: Fabian G
authors.initials: FG
authors.lastname: Krause
authors.forename: Olivia
authors.initials: O
authors.lastname: Fehlbaum
authors.forename: Lars M
authors.initials: LM
authors.lastname: Huebschle
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D001174:Arthrodesis; D001178:Arthroplasty; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005545:Forefoot, Human / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000601:surgery; D008875:Middle Aged; D009989:Orthotic Devices; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016138:Walking