Long-term results of metatarsal head-resection in deformities of the forefoot in rheumatoid arthritis

Between January 1983 and December 1987, metatarsal head-resections were per formed on 203 patients, comprising a total of 370 feet, using the Hueter/Ma yo and Hoffmann procedure. Seventy-two patients, comprising a total of 126 feet, were available for post-operative review after an average of 11.4 yea rs from the date of the original operations. The information obtained from standardized questionnaires was compared to the information found in each p atient's file. In addition, every available pre- and post-operative x-ray t aken from 1983 to 1987 was analyzed. Thus, with an average follow-up period of 5.6 years, the changes found in the pre- and post-operative x-rays from a total of 183 feet could be compared. Before the operations, nearly 100% of the examined feet suffered from painf ul synovial hypertrophy and erosion of the metatarsophalangeal joints with dislocation and subluxation, causing approximately 70% of all patients to h ave great difficulties in walking. After the operations, however, 90.2% of the patients reported that this condition had noticeably improved or had co mpletely disappeared. In fact, 87.5% of all patients reported a lasting imp rovement in their ability to walk longer distances. As the main criteria in determining the success of an operation (namely, th e noticeable reduction of pain and increased mobility) were achieved in 87. 5% of the patients, we consider the metatarsal head-resection a reliable me thod of correcting forefoot deformities in rheumatoid arthritis.