Rheumatoid forefoot reconstruction.

Management of the patient with rheumatoid forefoot deformity requires a multidisciplinary integrated approach for a successful outcome. Despite recent advances in the pharmacological management of rheumatoid arthritis and its impact upon disease progression, forefoot deformity and pain remain common manifestations requiring input from orthopaedic surgeons. The typical deformities encountered include hallux valgus, with subluxation or frank dislocation at the lesser metatarsophalangeal (MTP) joints. Surgical intervention is directed at correcting and decompressing these deformities, with the ultimate goal of a stable, painless, functional plantigrade foot. Although a variety of surgical options exist, fusion of the 1st MTP joint with lesser MTP joint excision arthroplasty remains the gold standard, upon which newer procedures should be judged. This article reviews the pathophysiology of forefoot deformity in rheumatoid arthritis with special emphasis on recent advances in surgical management.