title: Outcomes of modified metatarsal shortening offset osteotomy for forefoot deformity in patients with rheumatoid arthritis: Short to mid-term follow-up.
abstract: OBJECTIVE
  Advances in drug therapy for rheumatoid arthritis (RA) have been encouraging us to preserve the metatarsopharangeal (MTP) joint in correction of forefoot deformities, and original metatarsal shortening offset osteotomy was recommended as one of the conventional surgical options for forefoot deformities in RA cases. The objective of this study was to evaluate short- to mid-term outcomes of modified metatarsal shortening offset osteotomy.
  
  
  METHODS
  A retrospective observational study was completed for 80 RA cases (mean follow-up period: 3.2 years) who underwent modified metatarsal shortening offset osteotomy. Both lesser toe scales and RA foot ankle scales were administered using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a postoperative self-administered foot evaluation questionnaire (SAFE-Q) at final follow-up was also checked to evaluate clinical outcomes.
  
  
  RESULTS
  This procedure significantly improved clinical scores of both the JSSF [lesser toes and RA foot and ankle] scales. Of 80 feet, 24 (30%) showed recurrence of MTP joint subluxation/dislocation. Furthermore, the feet in the recurrence group showed significant varus hindfoot. On the other hand, valgus foot in the recurrence group more frequently included midfoot bony ankyloses. All of the affected feet showed the limitation of MTP joints (<70°) after surgery.
  
  
  CONCLUSIONS
  Modified metatarsal shortening offset osteotomy was recommended for RA forefoot disorders as one of the joint preservation surgeries in short- to mid-term follow-up. However, some modifications to avoid limitation of ROM in the MTP joint are required. It must be borne in mind that varus hindfoot and/or bony ankyloses in the mid-hindfoot can cause recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint.
authors.affiliation: a Department of Orthopaedics , Osaka University Graduate School of Medicine , Osaka , Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirao
authors.affiliation: a Department of Orthopaedics , Osaka University Graduate School of Medicine , Osaka , Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Ebina
authors.affiliation: b Department of Orthopaedics , Osaka Rosai Hospital , Osaka , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsuboi
authors.affiliation: c Department of Orthopaedics/Rheumatology , National Hospital Organization, Osaka Minami Medical Center , Osaka , Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Nampei
authors.affiliation: a Department of Orthopaedics , Osaka University Graduate School of Medicine , Osaka , Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kushioka
authors.affiliation: a Department of Orthopaedics , Osaka University Graduate School of Medicine , Osaka , Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Noguchi
authors.affiliation: c Department of Orthopaedics/Rheumatology , National Hospital Organization, Osaka Minami Medical Center , Osaka , Japan.
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Tsuji
authors.affiliation: d Department of Orthopaedics , Japan Community Health Care Organization (JCHO), Osaka Hospital , Osaka , Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Owaki
authors.affiliation: c Department of Orthopaedics/Rheumatology , National Hospital Organization, Osaka Minami Medical Center , Osaka , Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hashimoto
authors.affiliation: a Department of Orthopaedics , Osaka University Graduate School of Medicine , Osaka , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D005260:Female; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D033023:Foot Joints / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology
keywords: Forefoot deformity; hindfoot deformity; metatarsal shortening offset osteotomy; rheumatoid arthritis