title: Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options.
abstract: Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.
authors.affiliation: Department of Orthopaedic Surgery, Foot and Ankle Reconstruction Unit, St Maartenskliniek, Nijmegen, The Netherlands. j.louwerens@maartenskliniek.nl
authors.forename: Jan Willem K
authors.initials: JW
authors.lastname: Louwerens
authors.forename: Joost C M
authors.initials: JC
authors.lastname: Schrier
mesh_terms: D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016059:Range of Motion, Articular
references.citation: Foot Ankle Int. 1996 Mar;17(3):145-51
references.pmid: 8919618
references.citation: Int Orthop. 2001;25(5):312-6
references.pmid: 11794267
references.citation: Foot Ankle Int. 1994 Nov;15(11):575-80
references.pmid: 7849971
references.citation: Clin Orthop Relat Res. 1971 Jan;74:94-100
references.pmid: 5540410
references.citation: Foot Ankle. 1993 Jul-Aug;14(6):325-9
references.pmid: 8406247
references.citation: Foot Ankle Clin. 2007 Sep;12(3):435-54, vi
references.pmid: 17765838
references.citation: Acta Orthop Scand. 1983 Jun;54(3):417-21
references.pmid: 6858660
references.citation: J Bone Joint Surg Am. 1963 Oct;45:1517-36
references.pmid: 14069789
references.citation: J Bone Joint Surg Br. 1959 Aug;41-B:507-13
references.pmid: 13849835
references.citation: Scand J Rheumatol. 1975;4(4):225-33
references.pmid: 1198077
references.citation: Clin Orthop Relat Res. 1997 Jul;(340):48-57
references.pmid: 9224239
references.citation: J Foot Ankle Surg. 2011 Sep-Oct;50(5):522-4
references.pmid: 21683623
references.citation: Foot Ankle Int. 1999 Jul;20(7):438-43
references.pmid: 10437927
references.citation: Foot Ankle. 1988 Oct;9(2):75-80
references.pmid: 3224902
references.citation: J Bone Joint Surg Br. 2006 Jul;88(7):914-9
references.pmid: 16798995
references.citation: J Bone Joint Surg Am. 1992 Apr;74(4):564-70
references.pmid: 1583051
references.citation: Ann Surg. 1908 Aug;48(2):300-2
references.pmid: 17862221
references.citation: Foot Ankle Int. 1999 Oct;20(10):630-5
references.pmid: 10540993
references.citation: Clin Orthop Relat Res. 1975 May;(108):223-7
references.pmid: 1139830
references.citation: Acta Orthop Belg. 2007 Feb;73(1):88-95
references.pmid: 17441664
references.citation: Br J Rheumatol. 1995 May;34(5):443-8
references.pmid: 7788174
references.citation: Foot Ankle Surg. 2012 Jun;18(2):94-102
references.pmid: 22443994
references.citation: Clin Orthop Relat Res. 1982 Jun;(166):121-6
references.pmid: 7083658
references.citation: Foot Ankle Int. 2011 Jun;32(6):589-94
references.pmid: 21733420
references.citation: Foot (Edinb). 2012 Jun;22(2):81-4
references.pmid: 22280995
references.citation: J Bone Joint Surg Br. 1967 Aug;49(3):552-7
references.pmid: 6037570
references.citation: J Foot Ankle Surg. 2008 Mar-Apr;47(2):80-8
references.pmid: 18312914
references.citation: J Orthop Sci. 2001;6(2):141-7
references.pmid: 11484100
references.citation: Foot Ankle Surg. 2010 Sep;16(3):117-21
references.pmid: 20655010
references.citation: J Bone Joint Surg Br. 1973 Feb;55(1):126-33
references.pmid: 4693885
references.citation: J Bone Joint Surg Br. 1974 Aug;56B(3):527-33
references.pmid: 4422363
references.citation: Foot Ankle Spec. 2012 Feb;5(1):12-6
references.pmid: 22134438
references.citation: J Bone Joint Surg Am. 2000 Mar;82(3):322-41
references.pmid: 10724225
references.citation: J Bone Joint Surg Br. 1975 Nov;57(4):478-81
references.pmid: 1194316
references.citation: Clin Orthop Relat Res. 1997 May;(338):131-8
references.pmid: 9170374
references.citation: Foot (Edinb). 2009 Jun;19(2):110-3
references.pmid: 20307460
references.citation: Foot Ankle Int. 1995 Jan;16(1):1-6
references.pmid: 7697146
references.citation: Foot Ankle. 1982 Nov-Dec;3(3):173-80
references.pmid: 7152404
references.citation: Foot Ankle Int. 2005 Feb;26(2):135-9
references.pmid: 15737255
references.citation: J Rheumatol. 2003 Jul;30(7):1440-50
references.pmid: 12858439
references.citation: Clin Orthop Relat Res. 1972 Jan-Feb;82:24-31
references.pmid: 5011033
references.citation: J Bone Joint Surg Am. 1984 Jun;66(5):687-92
references.pmid: 6725317
references.citation: Ann R Coll Surg Engl. 1997 Jan;79(1):58-68
references.pmid: 9038498
references.citation: Clin Orthop Relat Res. 1989 Nov;(248):213-8
references.pmid: 2805483
references.citation: Clin Rheumatol. 2007 May;26(5):748-52
references.pmid: 17332985
references.citation: Scand J Rheumatol. 1980;9(4):257-65
references.pmid: 7455639
references.citation: Clin Orthop Relat Res. 1997 Jul;(340):39-47
references.pmid: 9224238
references.citation: J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:149-57
references.pmid: 16510808
references.citation: Acta Orthop Scand. 1991 Feb;62(1):63-6
references.pmid: 2003391
references.citation: Orthop Clin North Am. 1971 Nov;2(3):733-44
references.pmid: 5127587
references.citation: Foot Ankle Int. 1994 Nov;15(11):608-13
references.pmid: 7849976
references.citation: Foot Ankle Surg. 2011 Sep;17(3):158-65
references.pmid: 21783077
references.citation: J Bone Joint Surg Br. 2005 Sep;87(9):1171-7
references.pmid: 16129737
references.citation: Clin Orthop Relat Res. 1984 Nov;(190):249-53
references.pmid: 6488639
references.citation: Ann Rheum Dis. 1975 Aug;34(4):292-7
references.pmid: 1190849
references.citation: Clin Podiatr Med Surg. 2010 Apr;27(2):243-59
references.pmid: 20470956
references.citation: Arthritis Rheum. 2008 Nov 15;59(11):1596-602
references.pmid: 18975350
references.citation: Ann Rheum Dis. 2006 Sep;65(9):1254-5
references.pmid: 16905588
references.citation: Mod Rheumatol. 2008;18(5):486-91
references.pmid: 18568452
references.citation: J Rheumatol. 1992 Oct;19(10):1545-50
references.pmid: 1464866
references.citation: Foot Ankle Int. 2000 May;21(5):370-4
references.pmid: 10830653
references.citation: J Foot Ankle Surg. 2000 Nov-Dec;39(6):376-82
references.pmid: 11131474
references.citation: Clin Orthop Relat Res. 1997 Jul;(340):34-8
references.pmid: 9224237
references.citation: Acta Orthop Belg. 1992;58(1):11-5
references.pmid: 1561865
references.citation: Mod Rheumatol. 2010 Apr;20(2):147-53
references.pmid: 20012459
references.citation: J Foot Ankle Surg. 2006 Mar-Apr;45(2):107-12
references.pmid: 16513505
references.citation: Clin Orthop Relat Res. 1991 Apr;(265):4-8
references.pmid: 2009676
references.citation: J Bone Joint Surg Br. 2010 Mar;92(3):380-6
references.pmid: 20190309
references.citation: J Anat. 1954 Jan;88(1):25-30
references.pmid: 13129168
references.citation: Foot Ankle Int. 1997 Jul;18(7):391-7
references.pmid: 9252806
references.citation: Foot Ankle Int. 2011 Feb;32(2):131-40
references.pmid: 21288411
references.citation: Open Rheumatol J. 2012;6:290-5
references.pmid: 23066434
references.citation: Clin Orthop. 1960;16:136-40
references.pmid: 13810586
references.citation: J Foot Ankle Surg. 2012 May-Jun;51(3):308-11
references.pmid: 22225597
references.citation: Foot Ankle. 1980 Nov;1(3):159-66
references.pmid: 7319432
references.citation: Acta Orthop Scand. 1970;41(2):213-24
references.pmid: 5475321