Hypermobility of the first metatarsal bone in patients with rheumatoid arthritis treated by Lapidus procedure.
BACKGROUND
Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.


METHODS
The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray.


RESULTS
Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%).


CONCLUSIONS
The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.
1st Orthopaedic Clinic, 1st Faculty of Medicine, Charles University in Prague, V Úvalu 84, Prague 5, 150 06, Czech Republic. mudr.popelka@volny.cz
Stanislav
S
Popelka
Rastislav
R
Hromádka
Pavel
P
Vavřík
Vladislav
V
Barták
Stanislav
S
Popelka
Antonín
A
Sosna
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome