Conservation of metatarsal heads in surgery of rheumatoid arthritis of the forefoot.

A new method of forefoot reconstruction for rheumatoid arthritis in 79 patients is described in which the metatarsal heads are preserved. The first metatarsophalangeal joint is fused and the bases of the proximal phalanges of only those rays involved with disease excised together with cysts and synovium. Post-operatively traction is used to maintain the length of the operated lateral toes. The results in 71 patients followed for 3-5 years after operation are reported. Excellent pain relief, improved stability and feet of normal length are achieved.