A modified Hohmann method for hallux valgus and telescoping osteotomy for lesser toe deformities in patients with rheumatoid arthritis

Abstract

To preserve the function of metatarsophalangeal joints and to ensure forefoot stability in patients with rheumatoid arthritis (RA), we performed a modified Hohmann method for hallux valgus (HV) and telescoping osteotomy or shortening of lesser toe deformities. Forty-seven RA patients (90 feet) with severe HV and forefoot deformities were examined. The indication for the procedure in all the patients was disabling foot pain secondary to intractable plantar callosities below the lesser metatarsal heads and painful HV deformities. The HV and intermetatarsal (M1M2) angles and sesamoid complex were measured on the preoperative and postoperative roentgenograms. Visual analogue scales were studied preoperatively, postoperatively, and in the follow-up period. HV and M1M2 angles significantly improved compared between the pre- and postoperative conditions. Out of the 47 patients, 78.9% were satisfied with the results of the operation, 8.9% were unsatisfied, and 12.2% reported fair results. There were several complications, such as painful callosity, which was recurrent in seven feet, and delayed wound healing was observed in two out of the 90 feet. A modified Hohmann method and abductor hallucis muscle correction are effective in relieving pain and ensuring the bony union of the great toe in spite of severe osteoporosis.