Pathophysiologie rheumatischer Fußdeformitäten und operatives Patientenhandling

Abstract

Summary Rheumatoid arthritis is a systemic disease that often (85–100% of patient) affects the foot and ankle. In relation to the stage of disease there are characteristic deformities. Clinical assessment of both lower limbs is important, because factors like valgus deformity of the knee can cause malposition of the foot and ankle. In the early stage, patients present with joint effusion which causes destruction of the cartilage (“stiff-type”) and distends ligaments and capsules (“loosetype”). Medial and lateral ankle tendons become destroyed and insufficient. Reduction of walking distance, pain, instability and difficulties with footwear lead to a lack of life quality. The talonavicular joint and the rheumatoid forefoot destruction are in most cases the center problem of the foot deformity. Conservative treatment like orthotic shoe devices should be used in the early stage and are concomitantly used after surgical treatment. Rheumatoid arthritis is a systemic disease that requires an attentive handling perioperatively. Management of the special medication, concomitant diseases, skin, atlantoaxial instability, intraoperative bedding, anesthetic problems and higher risk for infection as well as the postoperative mobilization require special care and expertise.