Rheumatoid Forefoot Reconstruction: First Metatarsophalangeal Joint Fusion Combined with Weil’s Metatarsal Osteotomies of the Lesser Rays

Abstract

This study evaluates the outcome of rheumatoid forefoot reconstruction with arthrodesis of the first metatarsophalangeal joint (MTPJ) combined with multiple Weil's metatarsal osteotomies (WMO) to the lesser rays. A retrospective study on 17 consecutive patients (26 feet) was performed with subjective, clinical, and radiological analysis. At an average follow-up of 26.2 months, patients rated the result in 88% of cases as excellent or good with 76% improvement in pain, 74% improvement in function, and 70% improvement in footwear. This corresponded with a high mean modified AOFAS score of 72/100 (34 to 90). First MTPJ arthrodesis union rate was 92%. Fourteen percent of lesser toes were aligned preoperatively compared to 86% at latest review. There was a 12% rate of recurrent metatarsalgia and or callosities. This combined procedure provides stabilization of the first ray, offloading the lesser metatarsals and preventing early recurrence of deformity. Preserving the lesser metatarsal head further widens the surgical options if revisional surgery is necessary in the future. ACFAS Level of Clinical Evidence: 4.