Plantar pressure and surgical indication of toe arthroplasty for rheumatoid forefoot deformity.
OBJECTIVE
The objective of this study is to clarify the surgical indication for rheumatoid forefoot deformity according to background characteristics and plantar pressure.


METHODS
Patients with rheumatoid arthritis were divided into a non-surgical group (group N) and a surgical group (group S). The former consisted of 225 ft, and the latter consisted of 88 ft. DAS28, Japanese Society for Surgery of the Foot rheumatoid arthritis foot and ankle scale (JSSF scale) and hallux valgus angle (HVA) were evaluated as background characteristics. Distribution of peak pressure as plantar pressure was measured in nine sections.


RESULTS
In groups N and S, the mean DAS28 was 3.6 and 3.0, the mean JSSF scale was 81.1 and 63.0, and the mean HVA was 19.9° and 35.3°, respectively. The mean peak pressure of group S at the first and third metatarsophalangeal joints was significantly higher compared with group N. Significant differences between the two groups were also seen in Δ pressure (the difference between the maximum and minimum peak pressure values). The cut-off values were 75.0 for JSSF scale, 24.9° for HVA and 3.94 kg/cm2for Δ pressure.


CONCLUSIONS
The combined assessment of HVA and Δ pressure was found to be useful as an indication for surgical treatment of the forefoot.
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.|b Department of Orthopaedic Surgery , Nihon University School of Medicine , Tokyo , Japan.|c Department of Orthopaedic Surgery , Kawaguchi Municipal Medical Center , Saitama , Japan.
Hyunho
H
Lee
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Hajime
H
Ishikawa
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Yusuke
Y
Miyagawa
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Chinatsu
C
Takai
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Yumi
Y
Nomura
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Tetsuya
T
Nemoto
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Daisuke
D
Kobayashi
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Asami
A
Abe
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Hiroshi
H
Otani
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Satoshi
S
Ito
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Kiyoshi
K
Nakazono
b Department of Orthopaedic Surgery , Nihon University School of Medicine , Tokyo , Japan.|c Department of Orthopaedic Surgery , Kawaguchi Municipal Medical Center , Saitama , Japan.
Takao
T
Ishii
b Department of Orthopaedic Surgery , Nihon University School of Medicine , Tokyo , Japan.
Shu
S
Saito
b Department of Orthopaedic Surgery , Nihon University School of Medicine , Tokyo , Japan.
Yasuaki
Y
Tokuhashi
a Department of Rheumatology , Niigata Rheumatic Center , Niigata , Japan.
Akira
A
Murasawa
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001178:Arthroplasty / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011312:Pressure
Rheumatoid arthritis; forefoot deformity; plantar pressure; surgical indication; toe arthroplasty