Forefoot Surgery for Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory condition which can affect the forefoot by causing an inflammatory destruction of the small joints, most commonly the metatarsophalangeal joints.

Rheumatoid patients often have multiple deformities of the forefoot and surgery is recommended in some patients, but there is no set surgical recipe. Often all toes are affected and the toes drift towards the outside of the foot.

Figure 1: typical deformity of forefoot in rheumatoid arthritis

Figure 2: typical reconstruction for severe forefoot deformity

Rheumatoid patients often need all five toes corrected. This is an operation to relieve pain as a primary goal and patients are often quite low demand in terms of physical requirement post-op.

Success rates: most patients are satisfied with the procedure and have improvement of symptoms

 

Post-operative plan:

  • Surgery is a day-stay or overnight

  • Local anaesthetic is administered to help with post-operative pain

  • 0-2 weeks: elevation at home to reduce swelling, walk in post-operative flat shoe

  • 2-4 weeks: walk in post-operative shoe

  • 4-6 weeks: return to walking in comfortable shoes such as HOKA or ASICS

  • 6 weeks to 6 months: ongoing rehabilitation and physio, swelling may take up to 6 months to resolve.

Download post operative care guide 

Risks of surgery

  • Swelling, stiffness

  • Infection

  • Wound healing problems

  • Scar sensitivity

  • Ongoing pain

  • Recurrence of symptoms

  • Further surgery including removal of metal in approximately 10% of patients