Forefoot Reconstruction for Rheumatoid Arthritis
Orthopedic Surgery Clinic at 1 S. Park
Orthopedic Surgery Clinic at UW Hospital and Clinics
The orthopedic surgeons at UW Health's Foot and Ankle Clinic
in Madison, Wisconsin specialize in forefoot reconstruction as treatment for rheumatoid arthritis.
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.
X-ray of foot after reconstruction surgery
There are generally two options available for severe forefoot deformities. The initial treatment is conservative and involves working with a pedorthist. The pedorthist 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.
The most common surgical intervention to correct forefoot deformities is the Hoffman-Clayton procedure and first metatarsophalangeal arthrodesis (surgical stiffening of the joint). In essence, the bunion deformity is removed and the great toe fused, while the lesser toes are straightened.
The results of surgical forefoot reconstruction are generally very good to excellent. Several publications from the Journal of Foot and Ankle, as well as research from Dr. Rongstad’s and Dr. Guiao’s practices, demonstrated that about 95% of the 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. Of note, approximately half of the patients still required comfortable shoes with or without inserts post-operatively. In review of cases by Drs. Rongstad and Guiao over the past 13 years, the incidence of recurrent lesser toe deformities or great toe hardware removal is less than 10%. The best results are obtained in patients with lower physical demands. In these types of patients the satisfaction rate is similar to that after knee or hip replacement and makes this one of the most predictable procedures in orthopedic surgery.