Forefoot Reconstruction
Problems Associated with Rheumatoid Arthritis
Rheumatoid arthritis is a disease that affects 0.3 percent to 1.5 percent of the general population. Foot deformities are a major source of pain and disability. The frequency and degree of problems are directly related to the disease duration (i.e., the longer the disease, the greater the deformity).
A typical patient with rheumatoid forefoot disease may have components of hallux valgus (bunion deformity), metatarsalgia (pain over the ball of foot with loss of fat pad) and hammertoe deformities. There may be painful thick callous areas under the ball of the foot or on the tops of the toes.
Conservative Treatment
There are generally two options available for severe forefoot deformities. The initial treatment is conservative and involves working with a podiatrist. The podiatrist can modify existing shoewear or customize shoes and inserts to relieve pressure of prominent metatarsal heads, support unstable joints and provide room to accommodate the deformities. Orthotics and extra-depth shoes are often quite helpful and can provide excellent long-term relief.
Surgical Treatment
The most common surgical intervention to correct forefoot deformities is the Hoffman-Clayton procedure and first metatarsalphalangeal arthrodesis (surgical stiffening of the joint). In essence, the bunion deformity is removed and the great toe fused, while the lesser toes are straightened.
Post-surgical Results
The results of surgical forefoot reconstruction are generally very good to excellent. About 95% of patients are satisfied on long-term follow-up. Pain, limitations of activity and annoyance of the appearance of the foot are overwhelmingly improved after surgery.
