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Complications of Lesser Toe Surgery: How To Avoid Them before Surgery and How To Assess and Treat Them When They Have Occurred. Foot Ankle Clin 2022; 27:233-251. [PMID: 35680286 DOI: 10.1016/j.fcl.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Complications following lesser toe surgery are challenging to manage. The keys to treatment of any of these conditions are, first, to try to avoid them through identification of patient- and surgeon-related variables that contribute to their development and, second, following the occurance of a complication, to understand what can and cannot be corrected with surgical and nonsurgical management. This review provides a comprehensive assessment of current literature, demonstrates best practices and approaches to lesser toe complications, and provides an illustration of clinical examples.
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Yano K, Ikari K, Tobimatsu H, Okazaki K. Patient-Reported and Radiographic Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformities: A Retrospective Case Series with Mean Follow-up of 6 Years. J Bone Joint Surg Am 2021; 103:506-516. [PMID: 33475311 DOI: 10.2106/jbjs.20.01144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disorder and a chronic inflammatory disease that can damage joints throughout the body. As dramatic improvements in medical treatment have contributed to reduced progression of joint destruction, surgical methods for the treatment of RA-related forefoot deformities have gradually changed from joint-sacrificing to joint-preserving. The aim of this study was to assess the long-term outcomes, including patient-reported outcomes, of joint-preserving surgery for forefoot deformities associated with RA. METHODS This retrospective study included 105 feet in 89 patients with RA who were treated during the period of January 2012 to May 2015 and had a minimum of 5 years of follow-up (mean, 6.0 ± 0.9 years). The patient-reported outcome measure used was the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), which was completed preoperatively and at the latest follow-up (n = 53 feet). The hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the position of the medial sesamoid were measured preoperatively, at 3 months postoperatively, and at the latest follow-up. Cases of delayed wound-healing, hallux valgus recurrence, nonunion at the osteotomy sites, and reoperation were recorded. Kaplan-Meier survival curves were used to determine the estimated survivorship, with reoperation as the end point. RESULTS Scores of all 5 subscales of the SAFE-Q demonstrated significant improvement at the latest follow-up. The average HVA and IMA decreased significantly 3 months postoperatively, and these measurements remained significantly lower than the preoperative values (p < 0.01). The position of the medial sesamoid at the latest follow-up improved significantly (p < 0.01). Delayed wound-healing was found at the site of surgery in 21 (20.0%) of the 105 feet. Recurrence of hallux valgus was observed in 11 (10.5%) of the feet. There was no case of nonunion at any osteotomy site. Eleven (10.5%) of the feet required reoperation. The estimated survivorship of the studied joint-preserving surgery at 7 years, with reoperation as the end point, was 89.5%. CONCLUSIONS Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Koichiro Yano
- Department of Orthopedic Surgery (K.Y., K.I., H.T., and K.O.) and Institute of Rheumatology (K.Y., K.I., and H.T.), Tokyo Women's Medical University, Tokyo, Japan
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Yang TC, Tzeng YH, Wang CS, Chang MC, Chiang CC. Distal Metatarsal Segmental Shortening for the Treatment of Chronic Metatarsophalangeal Dislocation of Lesser Toes. Foot Ankle Int 2021; 42:183-191. [PMID: 33138646 DOI: 10.1177/1071100720961086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This retrospective study aimed to describe the techniques and results of distal metatarsal segmental shortening (DMSS) for the treatment of chronic irreducible metatarsophalangeal (MTP) dislocation of lesser toes. METHODS We retrospectively reviewed patients who underwent DMSS for chronic dislocation of MTP joints of lesser toes between January 2010 and December 2017 with follow-up of at least 24 months. Demographic data, radiographic measurements, functional outcomes, and complications were analyzed. Furthermore, the results of patients with short segment of shortening (group I, <10 mm) were compared to those with long segment of shortening (group II, ≥10 mm). A total of 43 MTP joints of 30 patients with an average age of 70.4 years were included. RESULTS Union was observed in 42 metatarsals (97.7%). Mean American Orthopaedic Foot & Ankle Society scale scores improved significantly from 42.2 (range, 15-65) preoperatively to 79.1 (range, 52-90) (P < .001). Mean visual analog scale pain score improved significantly from 5.0 (range, 1-9) preoperatively to 1.8 (range, 0-6) (P < .001). Complications included 1 nonunion, 1 osteonecrosis, 3 metatarsal angulation, 4 recurrent instability, 4 symptomatic osteoarthritis, 3 transfer metatarsalgia, and 1 floating toe. Group I included 23 MTP joints and group II included 20 MTP joints. There was no significant difference in clinical outcomes and complications between the 2 groups. CONCLUSION DMSS was a reliable procedure for the treatment of chronic irreducible dislocated MTP joint of lesser toes. It provided satisfactory surgical outcomes and a low rate of postoperative complications, regardless of length of metatarsal shortening. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei,Taiwan.,Department of Radiology, School of Medicine, National Yang-Ming University, Taipei,Taiwan
| | - Chien-Shun Wang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei,Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei,Taiwan
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Yammine K, Kheir N, Assi C. A Meta-Analysis of the Outcomes of Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers. Adv Wound Care (New Rochelle) 2021; 10:81-90. [PMID: 32870773 DOI: 10.1089/wound.2020.1261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Significance: Diabetic foot ulcers (DFUs) are associated with high morbidity, mortality, and health costs. Standard care (SC) associated with nonsurgical offloading is the mainstay treatment for DFUs, but it has high recurrence and infection rates. Metatarsal head resection (MHR) has been proposed as an effective surgical offloading technique for the treatment of plantar neuropathic DFUs, but with no evidence synthesis yet. Recent Advances: Based on PRISMA guidelines, a meta-analysis was conducted to assess the efficacy of MHR. Four electronic databases were searched for. Eleven studies met the inclusion criteria with a total of 477 patients (494 feet and 593 neuropathic forefoot ulcers). The studies included three retrospective comparative studies and eight case series. Critical Issues: Meta-analytical results of comparative studies on recent noninfected DFUs showed MHR having significantly better rates of healing, time to healing, ulcer recurrence, and infection than SC. Failure to heal, recurrence, and infection rates were 4 times higher in the SC group than in the MHR group, and the amputation rate was two times higher in the SC group than in the MHR group. The outcomes of the meta-analysis of case series on chronic and recalcitrant ulcers treated with MHR were similar. Future Directions: Considering the natural history of DFUs treated conservatively and the satisfactory outcomes with a significantly low complication rate of MHR, physicians should consider the use of MHR more often and include this technique in the early management of DFUs. Scope and Significance: DFU impose great public health burden around the globe. Standard of care using in-office debridement and topical agents is the usual mainstay of treatment. However, such conservative care is known to result in high rates of ulcer recurrence and complications. In this systematic review, we quantitatively investigate the outcomes of a surgical off-loading technique, the MHR in the treatment of chronic plantar neuropathic wounds. Translational Relevance: Many biochemical factors are implicated in the complex process of wound healing. In the case of diabetic neuropathic ulcers of the forefoot, additional mechanical factors induced by the presence of diabetic neuropathy lead to high pressure loads of the metatarsal heads on the plantar skin. With time, such chronic loads could favor ulcer formation. Removal of the causal mechanical factor could alleviate the pressure and allow wound healing. Clinical Relevance: Neuropathic plantar ulcers are difficult-to-heal wounds and chronicity is associated to frequent hospitalizations, higher rates of amputation, and mortality. Early removal of the indirect causal agent, the resection of the metatarsal head, after failure of a well-conducted conservative standard of care could be a needed solution for wound healing and consequently a potential for reducing complications and costs.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Nadim Kheir
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, School of Medicine, Lebanese American University, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
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Ortega-Avila AB, Moreno-Velasco A, Cervera-Garvi P, Martinez-Rico M, Chicharro-Luna E, Gijon-Noqueron G. Surgical Treatment for the Ankle and Foot in Patients with Rheumatoid Arthritis: A Systematic Review. J Clin Med 2019; 9:jcm9010042. [PMID: 31878151 PMCID: PMC7019508 DOI: 10.3390/jcm9010042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
The aim was to identify effective surgical treatments for patients with rheumatoid arthritis in the foot and/or ankle. A systematic review of the literature was conducted via a data search of the PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PROSPERO databases, from their inception until June 2019. Only non-randomized controlled trials and cohort studies were included in this review. Two of the present authors independently assessed the quality of each study and extracted the relevant data. A quality assessment of all articles was performed using the methodological index for non-randomized studies criteria. In addition, the Newcastle Ottawa scale was used for cohort studies. Thirteen studies met the inclusion criteria (five cohort studies and eight NRCTs). The total population considered was 923 patients (570 patients had RA), with a mean age of 58.8 years. Regarding the risk of bias, both the NRCTs and the cohort studies had a moderate level of quality. Despite the relatively low quality of these studies, surgical treatment for the foot and/or ankle is shown to reduce pain and improve functionality in patients with RA, in the short term (6–12 months).
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Affiliation(s)
- Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
- Correspondence:
| | - Antonio Moreno-Velasco
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Magdalena Martinez-Rico
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
| | - Esther Chicharro-Luna
- Department of Behavioural and Health Sciences, Nursing Area, Faculty of Medicine, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain;
| | - Gabriel Gijon-Noqueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga,29071 Malaga, Spain; (A.M.-V.); (P.C.-G.); (M.M.-R.); (G.G.-N.)
- Biomedical Research Institute (IBIMA), 29010 Malaga, Spain
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Schrier JC, Keijsers NL, Matricali GA, Verheyen CCPM, Louwerens JWK. Resection or preservation of the metatarsal heads in rheumatoid forefoot surgery? A randomised clinical trial. Foot Ankle Surg 2019; 25:37-46. [PMID: 29409260 DOI: 10.1016/j.fas.2017.07.1126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/28/2017] [Accepted: 07/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found. The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity. METHODS Patients suffering from well-defined rheumatoid forefoot deformity were prospectively enrolled in three institutions. This non-blinded study had a randomised clinical design and eligible patients were randomly assigned to undergo either resection of preservation of the MTH. The primary outcome measure consisted of the AOFAS score. Secondary outcome measures were: the FFI, the VAS for pain and the SF-36. RESULTS Twenty-three patients (10 in MTH preservation group) were included and analysed. After one year follow-up no significant differences in AOFAS score and additional outcome factors were found. A total of 10 complications in 23 patients were reported. CONCLUSIONS This randomised clinical study did not show significant clinical difference between a MTH resecting and a preserving procedure in patients suffering from rheumatoid forefoot deformity. Both procedures resulted in considerable improvement of pain and activity scores.
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Affiliation(s)
- Joost C Schrier
- Dept Orthopaedic Surgery, Medinova Clinics Breda, The Netherlands; Dept Orthopaedic Surgery, Sint Maartenskliniek Nijmegen, The Netherlands.
| | - Noel L Keijsers
- Dept Orthopaedic Surgery, Sint Maartenskliniek Nijmegen, The Netherlands
| | | | - Cees C P M Verheyen
- Dept Orthopaedic Surgery and Traumatology, Isala Hospital Zwolle, The Netherlands
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Abstract
Rheumatoid arthritis is a complex disease state with multiple associated comorbidities. Perioperative evaluation of the rheumatoid patient from a multidisciplinary approach is necessary to achieve favorable outcomes. A complete history and physical, laboratory, cervical, cardiovascular, pulmonary, and medication assessment before surgery should be performed. Educating the patient on potential complications, such as wound dehiscence, infection, and venous thromboembolism, as well as general postoperative expectations, is essential when evaluating the rheumatoid patient for surgery.
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Affiliation(s)
- Jesse Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA
| | - Joshua Wolfe
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA
| | - H John Visser
- Foot and Ankle Surgery Residency, SSM Health DePaul Hospital, 12303 DePaul Drive, Suite B1, St Louis, MO 63044, USA.
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8
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Abstract
Bunionette deformity, historically known as tailor's bunion, is a forefoot protuberance laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head. Although bunionette deformity has been compared to hallux valgus deformity, it is likely due to a multifactorial, anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance. Friction generated between the bony prominence, soft tissue, and associated constrictive footwear can result in keratosis, inflammation, pain, and ulceration. Symptomatic bunionettes are usually responsive to nonsurgical management. Surgical options are available based on the underlying bony deformity when nonsurgical treatment fails.
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Kalantar Motamedi A, Ansari M. Comparison of Metatarsal Head Resection Versus Conservative Care in Treatment of Neuropathic Diabetic Foot Ulcers. J Foot Ankle Surg 2018; 56:428-433. [PMID: 28268140 DOI: 10.1053/j.jfas.2016.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 02/03/2023]
Abstract
Complications from diabetic foot ulcers often lead to increased patient morbidity. Much debate still ensues concerning surgical versus conservative management of neuropathic diabetic foot ulcerations. The present study assessed and compared the efficacy of metatarsal head resection and medical approach in the treatment of neuropathic diabetic foot ulcers located at the plantar surface of metatarsal heads. In a retrospective cohort study, 24 consecutive neuropathic diabetic foot ulcers in the lower area of the metatarsal heads that had undergone metatarsal head resection were included as the operative group. For the control group, we included 25 similar ulcers that were scheduled for medical therapy. With respect to postoperative complications, wound healing occurred earlier in the operative group, and the recurrence rate was inversely greater in the medical treatment group. Also, the hospitalization rate was significantly greater in the medical treatment group. Overall, the long-term complication rate was lower in the operative than in the medical treatment group. Also, the infection rate was greater in the medical treatment group than in the operative group. Comparing early and late clinical outcomes of metatarsal head resection surgery and medical treatment showed complete superiority for the surgical approach, and metatarsal head resection is more completely cost beneficial than the medical approach.
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Affiliation(s)
- Alireza Kalantar Motamedi
- Assistant Professor of General Surgery, Subspecialist in Vascular Surgery, Department of Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Ansari
- General Practitioner, Department of Surgery, Rasoul-e-Akram Hospital, Iran University of Medical Science, Tehran, Iran.
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Meyr AJ, Mirmiran R, Naldo J, Sachs BD, Shibuya N. American College of Foot and Ankle Surgeons ® Clinical Consensus Statement: Perioperative Management. J Foot Ankle Surg 2017; 56:336-356. [PMID: 28231966 DOI: 10.1053/j.jfas.2016.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Indexed: 02/07/2023]
Abstract
A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.
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Affiliation(s)
- Andrew J Meyr
- Committee Chairperson and Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | | | - Jason Naldo
- Assistant Professor, Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Brett D Sachs
- Private Practice, Rocky Mountain Foot & Ankle Center, Wheat Ridge, CO; Faculty, Podiatric Medicine and Surgery Program, Highlands-Presbyterian St. Luke's Medical Center, Denver, CO
| | - Naohiro Shibuya
- Professor, Department of Surgery, Texas A&M, College of Medicine, Temple, TX
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Ishie S, Ito H, Azukizawa M, Furu M, Ishikawa M, Ogino H, Hamamoto Y, Matsuda S. Delayed wound healing after forefoot surgery in patients with rheumatoid arthritis. Mod Rheumatol 2014; 25:367-72. [DOI: 10.3109/14397595.2014.966975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rheumatoid forefoot reconstruction: outcome of 1st metatarsophalangeal joint fusion and the Stainsby procedure in the lesser toes. Foot (Edinb) 2014; 24:56-61. [PMID: 24684777 DOI: 10.1016/j.foot.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 02/15/2014] [Accepted: 02/27/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rheumatoid arthritis is a chronic inflammatory disease involving connective tissue and joints. The most common rheumatoid forefoot deformities are hallux valgus and clawed lesser toes. There are a number of surgical procedures that have been described offering symptomatic relief and anatomical correction. OBJECTIVES This prospective case series aims to assess outcome in patients with rheumatoid forefoot deformities who underwent a novel combination of 1st metatarsophalangeal joint fusions and Stainsby procedures. METHODS Thirteen procedures were performed on 12 consecutive patients with an age range of 55-71 (mean=62) between 02/2009 and 05/2011. AOFAS scoring was performed preoperatively and again six and 12 months post-surgery. Hallux valgus (HVA) and intermetatarsal angles (IMA) were measured preoperatively and six weeks and six months postoperatively. RESULTS The mean AOFAS score increased from 46 to 72, 12 months postoperatively. The mean HVA reduced from 48° preoperatively to 14° six months postoperatively. The IMA decreased from 15° to 10° six months postoperatively. CONCLUSIONS The novel approach of 1st metatarsophalangeal fusion combined with lesser toe metatarsal head sparing is an effective procedure that reduces forefoot deformity and pain.
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Loveday DT, Jackson GE, Geary NPJ. The rheumatoid foot and ankle: current evidence. Foot Ankle Surg 2012; 18:94-102. [PMID: 22443994 DOI: 10.1016/j.fas.2011.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/19/2011] [Accepted: 06/30/2011] [Indexed: 02/04/2023]
Abstract
The management of rheumatoid patients is a complex process due to the chronic, systemic, multi-joint and extra-articular nature of the disease. In comparison, osteoarthritis and post-traumatic arthritis usually involve a single joint and are hence not comparable to rheumatoid pathology. This review sets out to specifically look at studies on rheumatoid patients with interventions for foot or ankle disease. MEDLINE, EMBASE, the Cochrane databases, Current Controlled Trials and the WHO International Clinical Trials Registry Platform are all searched for relevant studies.
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Affiliation(s)
- David T Loveday
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral CH49 5PE, United Kingdom.
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14
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Abstract
Digital deformities continue to be a common ailment among many patients who present to foot and ankle specialists. When conservative treatment fails to eliminate patient complaints, surgical correction remains a viable treatment option. Proximal interphalangeal joint arthrodesis remains the standard procedure among most foot and ankle surgeons. With continued advances in fixation technology and techniques, surgeons continue to have better options for the achievement of excellent digital surgery outcomes. This article reviews current trends in fixation of digital deformities while highlighting pertinent aspects of the physical examination, radiographic examination, and surgical technique.
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Affiliation(s)
- James Good
- Podiatric Medicine and Surgical Residency PM&S-36, Truman Medical Center, Lakewood, 7900 Lee's Summit Road, Kansas City, MO 64139, USA.
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15
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Reeves CL, Peaden AJ, Shane AM. The complications encountered with the rheumatoid surgical foot and ankle. Clin Podiatr Med Surg 2010; 27:313-25. [PMID: 20470960 DOI: 10.1016/j.cpm.2009.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, degenerative, systemic disease that leads to the destruction of articular cartilage of the joints. Complications, including infection, delays in wound healing, malunion, nonunion, implant failure, and degeneration of adjacent joints soon after primary fusion, have been described in the literature and are generally accepted as commonplace in reconstructive surgeries of the foot and ankle. The combined efforts of the surgeon and supporting physicians to maintain optimal health for the patient, along with the principles discussed in this article, can lead to superior outcomes with fewer complications in the postoperative course.
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Affiliation(s)
- Christopher L Reeves
- Department of Podiatric Surgery (East Orlando Campus), Florida Hospital East Orlando, 7975 Lake Underhill Road, Suite 210, Orlando, FL 32822, USA.
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16
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Abstract
Familiarity with the systemic manifestations of rheumatoid arthritis as well as familiarity with drug therapy used for the management of rheumatoid arthritis may be helpful in the avoidance of some postoperative complications. Drug effects on soft tissues and bone may complicate reduction, stabilization, and fixation of deformities. Evaluation of the patient with rheumatoid arthritis for extraarticular disease may also explain symptomatology, and reduce the incidence of complications by unrecognized contributions of soft tissue pathology of osseous and articular disorders.
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Abstract
Rheumatoid arthritis is an autoimmune disorder that presents in females more often than males, and may affect people belonging to any age group. This disease shows no regional or ethnic preference. Although genetic and environmental causes have been proposed, the definitive cause of immunologic susceptibility, as well as viral and bacterial infectious processes that may cause rheumatoid arthritis, have not been identified. This article discusses various reconstructive forefoot surgeries to correct rheumatoid arthritis and the perioperative care of the patients who undergo surgery, along with the radiographic and magnetic resonance imaging findings associated with the disease.
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Abstract
The goal of the foot and ankle surgeon is to achieve balanced correction of deformity in patients who have rheumatoid arthritis (RA) while minimizing the risk for complications. To achieve these goals, a large number of procedures may be required at a single or in a staged operative setting. In this article, the evaluation of the patient to assess operative risks and the management of perioperative complications in the RA foot and ankle patient are presented.
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Affiliation(s)
- Christopher Bibbo
- Department of Orthopedics, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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Heitkemper S, Pingsman A, Quitmann A, Patsalis T. Korrektur des rheumatischen Vorfußes. DER ORTHOPADE 2007; 36:478-83. [PMID: 17440707 DOI: 10.1007/s00132-007-1065-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Resection of the metatarsal heads is an established procedure for the therapy of rheumatic forefoot deformations. However, a recurrence of lateral deviation of the lesser toes and painful plantar keratosis remain a challenging problem for the treatment of these patients. The aim of this study was to evaluate our results in cases of rheumatoid forefoot deformities. We performed a resection of the metatarsal heads 2-5 in combination with an arthrodesis of the first toe and resection of keratosis by the plantar approach. MATERIAL AND METHODS Fifteen patients (20 feet) were followed-up clinically and radiologically using the American Orthopedic Foot and Ankle Society (AOFAS), Miehlke-, and Larsen scores. RESULTS Average follow-up time was 3.5 years (range: 1.5-7.5 years). An average AOFAS score of 81/90 was found for the hallux and 90/100 for the lesser toes. A total of 18 feet were rated as pain free, while two feet showed some residual pain. Every case showed an harmonic cascade of the resection. All patients stated that the operation had improved their quality of life and that they would consent to undergoing it again. CONCLUSION Our results after arthrodesis of MP-1 and resection of the metatarsal heads 2-5 using the plantar approach were good compared to the data published in the literature.
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Affiliation(s)
- S Heitkemper
- Orthopädische Universitätsklinik Essen, Hufelandstrasse 55, 45147, Essen.
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