Subjective and Objective Outcomes of Surgery for Rheumatoid Forefoot Deformities Under the Current Treatment Paradigm

• DOI: 10.1053/j.jfas.2021.06.008
• Publication Date: 2021-06-19T14:59:54Z
• Authors: Masahiro Horita; Keiichiro Nishida; Daisuke Kaneda; Kenzo Hashizume; Yoshihisa Nasu; Ryuichi Nakahara; Kenta Saiga; Hideki Ohashi; Masahito Watanabe; Toshifumi Ozaki
• Keywords: Metatarsophalangeal Joint; Foot Deformities, Acquired; Forefoot, Human; Middle Aged; Arthroplasty; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Activities of Daily Living; Humans; Female; Aged; Retrospective Studies

We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.