title: Long-term outcome of joint-preserving surgery by combination metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  We report the long-term outcome of joint-preserving surgery by combining metatarsal osteotomies for shortening for forefoot deformity in patients with rheumatoid arthritis (RA).
  
  
  METHODS
  Forty-three patients (57 feet) aged 41.7-70.8 years (mean, 57.7 years) underwent a combination of first tarsometatarsal fusion and distal realignment (modified Lapidus procedure), shortening oblique osteotomies of the bases of metatarsals 2-4, and fifth ray osteotomy (modified Coughlin procedure). Patients were followed up for 64-108 months (mean, 76.6 months).
  
  
  RESULTS
  Average postoperative Foot Function Index scores for pain, disability, and activity were 10.3, 19.9, and 16.2, respectively. Average Japanese Society for Surgery of the Foot RA foot and ankle score improved significantly from 52.1 points preoperatively to 90.3 points postoperatively. Postoperatively, 41% of patients reported some forefoot stiffness, but showed no disability. Residual deformity and callosity were absent in all patients. Average hallux valgus and intermetatarsal angles decreased postoperatively from 48.5° to 8.6° and from 15.2° to 4.6°, respectively. Nonunion in two metatarsals, hardware breakage in three, and mild infection in one were identified during follow-up.
  
  
  CONCLUSIONS
  With good perioperative medical management of RA, surgical repositioning of the metatarsophalangeal joints by proximal metatarsal shortening and consequent relaxing of the surrounding soft tissue shows successful long-term results.
authors.affiliation: a Department of Orthopaedic Surgery , St. Marianna University School of Medicine , Kanagawa , Japan.
authors.forename: Hisateru
authors.initials: H
authors.lastname: Niki
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hirano
authors.forename: Yui
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mitsui
authors.forename: Hiroto
authors.initials: H
authors.lastname: Fujiya
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D005260:Female; D006215:Hallux Valgus / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Forefoot deformity; Joint-preserving surgery; Long-term outcome; Metatarsal shortening osteotomy; Rheumatoid arthritis