Dwyer's operation for the rheumatoid forefoot.

In 1970, A. F. Dwyer described an operation for severe toe deformities with the objectives of creating a more stable foot and improving toe function, in addition to relieving pain. This was achieved by fusing the metatarsophalangeal joint of the hallux and the proximal interphalangeal joints of the lateral four toes. The metatarsal heads of the second, third, fourth, and fifth rays were then resected with their respective extensor tendons interposed so as to provide a tenodesis effect. Our study presented in this paper consists of 36 consecutive procedures performed on 22 rheumatoid patients. Follow-up of 33 operations in the 20 patients who were available for recall averaged 42.2 months. Assessment emphasized a subjective report including patient satisfaction, relief of pain, ability to fit shoes, cosmetic result, and walking ability. Objective examination was used to evaluate the presence of a successful arthrodesis of the metatarsophalangeal joint of the great toe, the position of this arthrodesis, the presence of tender callosities, the attitude of the lateral four toes, and symmetry. Results were good or excellent in 76%, satisfactory in 12%, and poor in 12%.