title: Joint preserving surgery for rheumatoid forefoot deformities improves pain and corrects deformity at midterm follow-up.
abstract: BACKGROUND
  Rheumatoid arthritis is a chronic autoimmune disorder that commonly affects the metatarsophalangeal (MTP) joints. Conventional surgical treatment involves joint-sacrificing surgery to relieve pain and correct deformity.
  
  
  OBJECTIVE
  We retrospectively reviewed 49 patients with rheumatoid forefoot deformities who underwent 66 joint preserving procedures with Scarf osteotomy of the first metatarsal and Weil's shortening osteotomy of the lesser metatarsals.
  
  
  METHODS
  There were 5 males and 44 females with mean age 56.1 years and mean follow-up 51 months. All patients were evaluated clinically and radiologically with hallux valgus angle (HVA) and inter-metatarsal angle (IMA).
  
  
  RESULTS
  Mean AOFAS score improved from 39.8 preoperatively to 88.7 at final follow-up. Subjectively patients reported their outcome as excellent in 49 feet (74%), good in 9 feet, fair in 7 feet and poor in 1 foot. Five feet had residual stiffness and 11 residual pain. Mean HVA and IMA decreased from 32° to 14° and from 15° to 11° respectively.
  
  
  CONCLUSIONS
  In intermediate to severe stages of the disease, joint preserving surgery by Scarf osteotomy of the first MTP joint and Weil osteotomy of the lesser metatarsals may be performed as an alternative to joint-sacrificing procedures and should be considered as a complement to the various surgical treatments of the rheumatoid forefoot.
authors.affiliation: Department of Orthopaedic Surgery, Darlington Memorial Hospital, Darlington, UK. moinmb@gmail.com
authors.forename: Mainudden
authors.initials: M
authors.lastname: Bhavikatti
authors.forename: Mathew David
authors.initials: MD
authors.lastname: Sewell
authors.forename: Nawfal
authors.initials: N
authors.lastname: Al-Hadithy
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Awan
authors.forename: M A
authors.initials: MA
authors.lastname: Bawarish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult