More than 20 years' follow-up of metatarsal neck shortening oblique osteotomy for rheumatoid forefoot deformity

Impact of Foot Surgery and Pharmacological Treatments on Functionality and Pain in Rheumatoid Arthritis: A Five-Year Longitudinal Study

BACKGROUND

Rheumatoid arthritis (RA) frequently leads to foot deformities, significantly impacting pain, mobility, and quality of life. Surgical and pharmacological treatments are prescribed to manage symptoms, but their long-term effects on foot function remain unclear. This study evaluates the impact of different treatment approaches, including surgery, methotrexate (MTX), and biological therapy (Bio), on foot functionality and pain progression over five years.

METHODS

A longitudinal cohort study was conducted with 103 RA patients classified into five groups: surgery, MTX < 10 years, MTX ≥ 10 years, Bio < 10 years, and Bio ≥ 10 years. Data from 2018 and 2023 were compared using the Visual Analog Scale (VAS), the Manchester Foot Pain and Disability Index (MFPDI), and the Foot Function Index (FFI). Statistical analyses included ANOVA, Kruskal-Wallis, and ROC curve analysis to assess differences between groups and identify key progression factors.

RESULTS

Patients with ≥10 years of disease duration and non-biological treatment (MTX ≥ 10 years) experienced the most severe deterioration in foot function, with a mean FFI increase of +11.89 points (p < 0.01). In contrast, MTX < 10 years was the only group to show an improvement in foot function (FFI: -5.29, p = 0.02). The surgery group exhibited moderate but highly variable functional changes, while patients on biological therapy showed less progression in pain and disability compared to their non-biologic counterparts. Hallux abductus valgus severity increased across all groups.

CONCLUSIONS

Patients with long-standing RA on non-biologic therapy exhibited the greatest decline in foot function, whereas early treatment with MTX (<10 years of disease duration) appeared to slow deterioration. Surgery did not consistently provide functional benefits, and biologics helped mitigate progression, though outcomes varied. These findings underscore the importance of early intervention and personalized treatment strategies for foot preservation in RA.

Outcomes of Joint-Preserving Surgery for Forefoot Deformities in Patients With Rheumatoid Arthritis

BACKGROUND

With the advent of effective disease-modifying medications, the surgical treatment of forefoot deformities in patients with rheumatoid arthritis (RA) has evolved from joint-sacrificing to joint-preserving surgery. However, it is unclear whether joint-preserving surgery is effective for the full range of metatarsophalangeal joint involvement. Hence, this study investigated the postoperative outcomes of joint-preserving surgery for rheumatoid forefoot deformities with a wide range of joint destruction.

METHODS

This retrospective observational study included 68 feet from 68 patients with RA who underwent joint-preserving surgery for forefoot deformities between 2014 and 2020. The Larsen grade classification was used to assess the first metatarsophalangeal joint destruction and classify patients into 4 groups as follows: 0 and 1 (n = 14), 2 (n = 21), 3 (n = 19), and 4 and 5 (n = 14). The Self-Administered Foot and Ankle Evaluation Questionnaire (SAFE-Q) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were determined before surgery and at the last follow-up visit.

RESULTS

The median observation duration was 40 (range, 24-78) months. SAFE-Q scores of all groups significantly improved in all subscales at the last observation, with no significant differences among the study groups. Radiographic evaluations of all groups revealed significant improvements in HVA and IMA after surgery, with no significant differences among the groups.

CONCLUSION

In patients using the surgical approaches described in this study, joint-preserving surgery for rheumatoid forefoot deformities led to satisfactory clinical and radiographic improvements, regardless of the severity of joint destruction.

LEVEL OF EVIDENCE

Level III, case-control study.