ARTHROPLASTY FOR RHEUMATOID FOREFOOT DEFORMITIES BY A SHORTENING OBLIQUE OSTEOTOMY

Seventy-five feet in 47 patients (46 women, 1 man) who had rheumatoid arthritis were observed for an average of 6 years (range, 1-11 years) after an operation on the forefoot that included a shortening oblique osteotomy of the metatarsal neck of the lateral toes, In addition, pat ients underwent either flexible hinge toe implant arthroplasty or Mitc hell's osteotomy in the first metatarsophalangeal joint, Forty-two fee t (56%) looked normal with no valgus or dorsal displacement of the toe s, Recurrence of callosities occurred in 9 feet (12%) with moderate pa in in 3 feet, Thirty-nine (83%) patients were satisfied with the outco me after surgery, Resection arthroplasty often is recommended for mana gement of forefoot deformities, However, as shown in this series, the improvement in deformities, function, and cosmesis of metatarsophalang eal joint preservation may be better with an osteotomy of the metatars al neck than with a resection arthroplasty, Because of the development of combined drug therapy, the benefits of synovectomy, osteotomy, and shortening in length should be reconsidered. The authors' studies sug gest that the shortening oblique osteotomy should be considered 1 of t he surgical reconstruction options for patients with rheumatoid arthri tis who have forefoot deformities.