title: Preference of surgical procedure for the forefoot deformity in the rheumatoid arthritis patients--A prospective, randomized, internal controlled study.
abstract: OBJECTIVE
  The deformed rheumatoid forefoot may be treated with resection of lesser metatarsal heads combined with arthrodesis or resection of the first metatarsophalangeal joint. Recurrent hallux valgus deformity has been reported by resection. We performed a prospective, randomized, internal-controlled study to compare results between arthrodesis and resection.
  
  
  METHODS
  We resected the lesser metatarsal heads bilaterally and performed arthrodesis of the first metatarsophalangeal joint on one side and resection on the opposite side. We investigated 26 patients (52 feet) who were followed at least one year. Patients were assessed for clinical score, hallux valgus angle (HVA), angle between first and second metatarsals, and angle between first and fifth metatarsals preoperatively, postoperatively and at final follow-up. We evaluated callosities, claw toes, recurrences, and procedure preferences.
  
  
  RESULTS
  The mean follow-up period was 4.1 years. No significant differences between arthrodesis and resection were seen, with the exception of HVA. That was significantly less on arthrodesis side (11.5°) than on resection side (17.0°, p < 0.05). Seven callosities on resection side and four on arthrodesis side were observed. On resection side, hallux valgus deformity often recurred (15.3%). Patients expressed a significant preference for arthrodesis over resection (p = 0.008).
  
  
  CONCLUSIONS
  Arthrodesis provides better results for maintaining HVA.
authors.affiliation: Departments of Orthopaedic Surgery, Osaka City University Medical School , Osaka , Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tada
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Koike
authors.forename: Tadashi
authors.initials: T
authors.lastname: Okano
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sugioka
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Wakitani
authors.forename: Kenji
authors.initials: K
authors.lastname: Mamoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D001174:Arthrodesis; D005260:Female; D005545:Forefoot, Human / Q000601:surgery*; D006215:Hallux Valgus / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D016896:Treatment Outcome
keywords: Arthrodesis; Clinical results; Forefoot deformity; Resection; Rheumatoid arthritis