Review article

SURGICAL TREATMENT OF THE RHEUMATOID FOOT

Ivica Lucijanić ; Opća bolnica Karlovac
Sonja Milanović
Iva Lucijanić

Abstract

The aim of this article is to present certain facts associated with rheumatoid foot surgery. Arthritic disease processes attack the joints, ligaments, tendons, cartilage, and bones, causing deformity, pain, and loss of function. Their effect on the feet can be devastating. Deformities secondary to rheumatoid arthritis are more severe than those in
other forms of arthritic diseases. A common deformity of the forefoot is hallux valgus. The lesser metatarsophalangeal joints, especially the second one, commonly show lateral subluxation and total dislocation, and the toes develop flexion of the proximal interphalangeal joint and flexion or extension of the distal interphalangeal joint. The hindfoot is less affected by the disease process, most oft en only in the late stage of the disease. Great progress has been made in the medical and surgical treatment of arthritic diseases. Several reconstructive procedures can be performed. For first ray deformities: first metatarsophalangeal joint fusion, Mayo or Keller resection, implant arthroplasty, synovectomy, proximal osteotomy of the first metatarsal, and metatarsocuneiform fusion. For lesser metatarsophalangeal joints: extensor tenotomies, open metatarsophalangeal joint release, synovectomy, base resection, metatarsal condylectomy, metatarsal head resection, base and metatarsal head resection, and lesser metatarsal osteotomy. For the toes: proximal interphalangeal joint arthroplasty, proximal interphalangeal joint fusion, distal interphalangeal joint arthroplasty, proximal phalangeal base resection, and digital stabilization by syndactylization. Resection arthroplasty improves motion by shortening skeletal structures and providing new gliding surfaces, but the results are unpredictable. For the rheumatoid
hindfoot, arthrodesis of the talonavicular, subtalar, calcaneocuboid, and tibiotalar joints or ankle arthroplasty can be performed. The results of a well-planned and performed surgical treatment, indicated in time, are usually good. Co-operation between the patient, rheumatologist, and surgeon is required.

Keywords

Rheumatoid arthritis; Foot deformities, acquired; Forefoot, human; Metatarsophalangeal joint; Hallux valgus; Arthroplasty; Arthrodesis; Osteotomy; Synovectomy

Hrčak ID:

212227

URI

https://hrcak.srce.hr/212227

Publication date:

6.12.2018.

Article data in other languages: croatian

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