Metatarsal head resection in the deformed, symptomatic rheumatic foot. A comparison of two methods.

Metatarsal head resection for the symptomatic, deformed, rheumatic foot was performed in 83 feet of 49 patients via a modified plantar approach with functional after treatment, and in 64 feet of 41 patients via a dorsal approach, followed by placement in a plaster cast for 6 weeks. Both groups were comparable with regard to age, sex, and follow-up. From 1975 to 1985, 147 feet (90 patients) were operated in two different hospitals. Of these, 25 patients (39 feet) were lost to follow-up. The average follow-up was 83.3 mo. (range 33-136 mo.). Data were obtained by studying the medical records and by questionnaires sent to all patients. The results in both groups were quite similar. However a higher rate of wound-healing problems was found with the dorsal approach. The plantar approach resulted in an increase recurrence of metatarsalgia, requiring surgical revision.