The Combination of Modified Mitchell’s Osteotomy and Shortening Oblique Osteotomy for Patients with Rheumatoid Arthritis: An Analysis of Changes in Plantar Pressure Distribution

Hyunho Lee,Kazuyoshi Nakanishi,Tetsuya Nemoto,Kaoru Abe,Chinatsu Takai,Akira Murasawa,Asami Abe,Hajime Ishikawa,Tatsuaki Shibuya,Kiyoshi Nakazono,Yumi Nomura,Hiroshi Otani,Satoshi Ito

doi:10.3390/ijerph18199948

Abstract

The present study aims to evaluate changes in plantar pressure distribution after joint-preserving surgery for rheumatoid forefoot deformity. A retrospective study was performed on 26 feet of 23 patients with rheumatoid arthritis (RA) who underwent the following surgical combination: modified Mitchell’s osteotomy (mMO) of the first metatarsal and shortening oblique osteotomy of the lateral four metatarsals. Plantar pressure distribution and clinical background parameters were evaluated preoperatively and one year postoperatively. A comparison of preoperative and postoperative values indicated a significant improvement in the visual analog scale, Japanese Society for Surgery of the Foot scale, and radiographic parameters, such as the hallux valgus angle. A significant increase in peak pressure was observed at the first metatarsophalangeal joint (MTPJ) (0.045 vs. 0.082 kg/cm2; p < 0.05) and a significant decrease at the second and third MTPJs (0.081 vs. 0.048 kg/cm2; p < 0.05, 0.097 vs. 0.054 kg/cm2; p < 0.05). While overloading at the lateral metatarsal heads following mMO has been reported in previous studies, no increase in peak pressure at the lateral MTPJs was observed in our study. The results of our study show that this surgical combination can be an effective and beneficial surgical combination for RA patients with mild to moderate joint deformity.

Highlights

Patients with rheumatoid arthritis (RA) are susceptible to a variety of foot problems that result in the limitation of activity in their daily lives [1,2,3]
The purpose of the present study is to investigate the changes in plantar pressure distribution in RA patients using this same combination of surgical procedures
A retrospective study was conducted in RA patients who had undergone a surgical combination consisting of an modified Mitchell’s osteotomy (mMO) and an shortening oblique osteotomy (SOO) at our hospital from May 2012 to September

Summary

Introduction

Patients with rheumatoid arthritis (RA) are susceptible to a variety of foot problems that result in the limitation of activity in their daily lives [1,2,3]. In the progression of rheumatoid arthritis and forefoot deformities, such as subluxation or dislocation of the metatarsophalangeal joint (MTPJ) in the lesser toe, hallux valgus, and spread foot, often occur due to a decrease in the transverse foot arch, and painful callosities are frequently formed in the forefoot. Foot health is clearly a major factor in the quality of life of RA patients [4] and should be a primary consideration in the selection of appropriate treatment. In RA patients with painful callosities, treatment methods such as foot orthoses and foot care have been attempted.

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