TREATMENT OF RHEUMATOID-ARTHRITIS DEFORME D FOREFOOT BY OPERATION AFTER LELIEVRE

From January 1986 to December 1990 we treated 57 patients with rheumat oid arthritis deformed forefoot by the Lelievre procedure in 70 cases (13 patients on both sides). The purpose of this investigation was to analyse the outcome of this specific operation and to find reasons for an unsatisfactory result. We investigated retrospectively 31 patients with a total of 44 operations at a median follow-up time of 5 years a nd 3 months. The examination included a subjective, objective, and rad iological assessment of the outcome of this kind of surgical treatment for rheumatoid forefoot destruction. The results demonstrated that 77 % of the operated feet were now free of pain or the pain was dramatica lly reduced. Patients with persisting complaints had a recurrence of p lantar callosities and sometimes a fibular shift of toes. The reason f or this was, besides insufficiently resected metatarsal heads, the pro gression of CP with destruction of other joints of the foot Evaluation of the metatarsal index showed that the plus-minus index was continuo usly associated with good results, whereas the plus index always went along with a poor result. Lelievre's procedure performed with exact in traoperative preparation obtaining a plus-minus metatarsal index produ ces very good results and can therefore be recommended for surgical tr eatment of the forefoot deformed by rheumatoid arthritis.