title: Rheumatoid forefoot reconstruction: outcome of 1st metatarsophalangeal joint fusion and the Stainsby procedure in the lesser toes.
abstract: BACKGROUND
  Rheumatoid arthritis is a chronic inflammatory disease involving connective tissue and joints. The most common rheumatoid forefoot deformities are hallux valgus and clawed lesser toes. There are a number of surgical procedures that have been described offering symptomatic relief and anatomical correction.
  
  
  OBJECTIVE
  This prospective case series aims to assess outcome in patients with rheumatoid forefoot deformities who underwent a novel combination of 1st metatarsophalangeal joint fusions and Stainsby procedures.
  
  
  METHODS
  Thirteen procedures were performed on 12 consecutive patients with an age range of 55-71 (mean=62) between 02/2009 and 05/2011. AOFAS scoring was performed preoperatively and again six and 12 months post-surgery. Hallux valgus (HVA) and intermetatarsal angles (IMA) were measured preoperatively and six weeks and six months postoperatively.
  
  
  RESULTS
  The mean AOFAS score increased from 46 to 72, 12 months postoperatively. The mean HVA reduced from 48° preoperatively to 14° six months postoperatively. The IMA decreased from 15° to 10° six months postoperatively.
  
  
  CONCLUSIONS
  The novel approach of 1st metatarsophalangeal fusion combined with lesser toe metatarsal head sparing is an effective procedure that reduces forefoot deformity and pain.
authors.affiliation: Royal Liverpool and Broadgreen University Hospital Trust, Prescot Street, Liverpool L7 8XP, UK. Electronic address: E_bass@hotmail.co.uk.
authors.forename: Edward James
authors.initials: EJ
authors.lastname: Bass
authors.affiliation: Royal Liverpool and Broadgreen University Hospital Trust, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: Raheel
authors.initials: R
authors.lastname: Shariff
authors.affiliation: Royal Liverpool and Broadgreen University Hospital Trust, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: Siva Prasad
authors.initials: SP
authors.lastname: Sirikonda
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology / Q000601:surgery*; D005531:Foot Deformities, Acquired / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D014034:Toes / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arthritis; Forefoot; Fusion; Reconstruction; Rheumatoid; Stainsby