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Proximal rotational closing-wedge osteotomy of the first metatarsal in rheumatoid arthritis: clinical and radiographic evaluation of a continuous series of 35 cases

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Objectives

The introduction of powerful antirheumatic drugs has dramatically improved the treatment of rheumatoid arthritis (RA), leading clinicians to reconsider the benefits of joint preservation for rheumatoid forefoot deformities. We have employed joint-preserving forefoot surgeries, including rotational closing-wedge osteotomy of the first metatarsal. The aim of our study is to assess the short-term results of this procedure.

Methods

From January 2011 through December 2011, 35 feet were treated with this procedure. Subjective, functional, and radiographic outcomes were surveyed.

Results

The mean Japanese Society for Surgery of the Foot improved from a preoperative level of 52.6 to 68.7 postoperatively. The average hallux valgus and intermetatarsal angles improved from 47.3° preoperatively to 17.5° postoperatively, and from 16.7° preoperatively to 9.0° postoperatively, respectively. To assess the repositioning of pronation deformities of the first metatarsal, the position of the medial sesamoid was also surveyed according to the measurement system proposed by Hardy and Clapham. All feet except two were classified as grade V or higher preoperatively; 25 of these were grade IV or lower at the latest follow-up.

Conclusions

Rotational closing-wedge osteotomy of the first metatarsal was beneficial for correcting forefoot deformities in RA over the short term.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada, Shinjuku, Tokyo, 162-0054, Japan

    Koichiro Yano, Katsunori Ikari, Takuji Iwamoto, Asami Saito, Yurino Naito, Kosei Kawakami, Taku Suzuki, Hitoshi Imamura, Yu Sakuma, Ryo Hiroshima & Shigeki Momohara

Authors
  1. Koichiro Yano
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  2. Katsunori Ikari
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  3. Takuji Iwamoto
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  4. Asami Saito
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  5. Yurino Naito
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  6. Kosei Kawakami
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  7. Taku Suzuki
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  8. Hitoshi Imamura
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  9. Yu Sakuma
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  10. Ryo Hiroshima
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  11. Shigeki Momohara
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Corresponding author

Correspondence to Katsunori Ikari.

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Yano, K., Ikari, K., Iwamoto, T. et al. Proximal rotational closing-wedge osteotomy of the first metatarsal in rheumatoid arthritis: clinical and radiographic evaluation of a continuous series of 35 cases. Mod Rheumatol 23, 953–958 (2013). https://doi.org/10.1007/s10165-012-0776-9

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  • DOI: https://doi.org/10.1007/s10165-012-0776-9

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