PEG-IN-HOLE ARTHRODESIS (OF THE PROXIMAL INTERPHALANGEAL JOINTS) AS ACOMPLEMENT TO TILLMANNS FOREFOOT RECONSTRUCTION

The operative treatment of forefoot deformities in rheumatoids is nowa days mostly done via the plantar approach - described by Tillmann and Hoffmann. For the correction of claw toes is it necessary to perform a n additional arthrodesis of the PIP-joints in some cases, the so-calle d Peg-in-Hole. In 83 forefoot deformities in rheumatoid disorders 209 arthrodeses of this type were performed. The follow-up period ranges f rom 6-42 months with an average of 18 months. A rating score was used including pain, gait, ability to stand on tip-toe, toe index, and comp lications. A very satisfactory result was obtained in 80%. A good or a cceptable result was obtained in 19 cases; 1 patient had a poor outcom e. 65% of the cases were absolutely pain-free and 35 had mild sporadic pain. The Peg-in-Hole arthrodesis results in a good correction of cla w-toes with a good ground contact of the toes, so that gait control is possible again. The rate of complications is very low in this procedu re (1%). That is why additional arthrodesis in the operative treatment of the forefoot as described by Tillmann is a recommendable technique .