Arthrodesis Compared to Mayo Resection of the First Metatarsophalangeal Joint in Total Rheumatoid Forefoot Reconstruction

Abstract

Painful forefoot deformity from rheumatoid arthritis can be treated with resection of the lesser metatarsal heads combined with either resection or arthrodesis of the first metatarsophalangeal (MTP) joint. In a prospective, randomized study we compared arthrodesis of first MTP joint with Mayo resection as part of total forefoot reconstruction in patients with painful forefoot deformity from rheumatoid arthritis. The lesser metatarsal heads were resected and extensor tenotomy was done in all patients. Thirty-one patients were randomized to either the arthrodesis or resection group. After a mean followup of 36 (26 to 52) months, the median subjective satisfaction score was 96 points out of 100 in the resection group and 92 points in the arthrodesis group. Significant improvements in pain, handicap, and activity according to Foot Function Index (FFI) were found in both groups (p <0.001 except for handicap in resection group and activity in fusion group were p=0.02). There were no statistically significant differences between the groups in these measures, nor in the patients' willingness to have the procedure again. There were no recurrences of prominences or tenderness under the forefoot in either group and no recurrence of severe hallux valgus in the resection group. The arthrodeses healed in 93%. There was no higher risk for clinically relevant IP joint symptoms after arthrodesis. The operating time was significantly longer in the arthrodesis group but this was not linked to a higher wound infection rate. These results indicate that Mayo resection may still be a good choice for the first MTP joint in total forefoot reconstruction in patients with rheumatoid arthritis.