Abstract
BackgroundFoot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability.MethodsThe study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray.ResultsData of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3%) in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%).ConclusionThe Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.
Highlights
Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis
While others are less precise and difficult to use in clinical practice [12,13,14,15,16]. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure [9,10] due to progression of subjective symptoms
Signs and symptoms of first metatarsal bone (MTT) instability in clinical and X-ray examinations were found in 92 feet (64.3%) in our group (Table 1)
Summary
Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. The impaired CM joint causes the first metatarsal bone (MTT) to become unstable in the frontal and sagittal planes [1,2,3]. Hypermobility of the first MTT contributes significantly to the development of hallux valgus and plays an important role even in its treatment. Lapidus [9,10] found that increasing hypermobility of the first MTT leads to development of hallux valgus. Voellmicke [11] prefers the term “dorsal instability of the first MTT” over the term hypermobility, which is more appropriate for overall joint hypermobility
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