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Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options

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Abstract

Despite recent advances in pharmacological management of rheumatoid arthritis, forefoot deformity, with its symptoms, remains a common problem, often requiring operative treatment. Typical deformities in these patients comprise hallux valgus and deformity of the lesser metatarsophalangeal (MTP) joints and toes. With regard to the lesser rays the standard operative procedure, advocated for the disabling forefoot pain in these patients, remains metatarsal head resection. It should be considered that with increasing success of pharmacological treatment the degree of forefoot deformity in these patients is becoming less and that resection of the lesser MTP joints is becoming more and more superfluous. This supports a trend towards metatarsal head-preserving surgery. The optimal treatment of the hallux deformity remains unclear. Fusion of the first MTP joint is, generally, recommended. This article will discuss the current surgical options in rheumatoid forefoot pathology.

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Acknowledgments

Each author has participated in the writing of the manuscript and assumes full responsibility for the content of the manuscript. There are no conflicts of interest. No funds were received in support of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Foot and Ankle Reconstruction Unit, St Maartenskliniek, Nijmegen, The Netherlands

    Jan Willem K. Louwerens

  2. Department of Orthopaedic Surgery and Traumatology, Isala Klinieken, Zwolle, The Netherlands

    Joost C. M. Schrier

  3. Department of Orthopaedic Surgery, Foot and Ankle Reconstruction Unit, St Maartenskliniek, PO Box 9011, 6500 GM, Ubbergen, The Netherlands

    Jan Willem K. Louwerens

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Correspondence to Jan Willem K. Louwerens.

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Louwerens, J.W.K., Schrier, J.C.M. Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options. International Orthopaedics (SICOT) 37, 1719–1729 (2013). https://doi.org/10.1007/s00264-013-2014-2

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