SURGICAL-TREATMENT OF RHEUMATOID FOREFOOT WITH REALIGNMENT USING A DORSAL APPROACH

Purpose of the study The aim of this study was to appreciate the resul ts of the modified Fowler's procedure in the surgical treatment of for efoot deformities due to rheumatoid arthritis. Material and method If the principles of the metatarsophalangeal resection through a dorsal t ransverse incision were conserved, we progressively modified the initi al procedure with renunciation to the plantar skin incision, preservat ion of a skin bridge between the medial and transverse dorsal approach , using centro medullary pins to hold in position toes alignement and making an arthrodesis of the first metatarsophalangeal joint. Ten pati ents (17 surgical procedures) were clinically and roentgenographically reviewed at an average follow-up of 27,3 months (Range: 12 and 53 mon ths). Results Clinical results according to the Gainer scale showed an increase of the overall score from 3,4 points to 11,2 points at revis ion. Twelve foot were rated excellents and five goods. Seventy per cen t of patients had no pain and 58 per cent used a normal footwear. Radi ographical and clinical analysis showed that an egyptian foot remained in nine cases, podoscopic examination revealed frequently a lack of f ootrest on lateral toes whithout functional implications. Delayed woun d healing were observed in four cases with good evolution. Conclusion With this surgical procedure, our functional results were encouraging and we recommand it in severe deformities of the rheumatoid foot with fixed metatarsophalangeal dislocations and bone defect of the metatars al heads.