[Effect of arthroplasty of the first metatarsophalangeal joint and shortening valgus osteotomy of the first metatarsus on forefoot surgery in rheumatoid arthritis].

Results of forefoot surgery with rheumatoid arthritis were evaluated in 19 feet of 11 patients. Clayton's operation was performed on 12 feet of 7 patients. The follow-up averaged 3 years and 10 months (range, 2 years and 1 month to 8 years). 1 foot (8.3%) recurred hallux valgus deformity and 3 feet (25%) recurred hammer toe deformity. But all patients complained of difficulties to push off action on the forefoot. Interpositional arthroplasty of the first metatarsophalangeal joint with shortening-valgus osteotomy through the first metatarsal base was done on 7 feet of 4 patients. The follow-up averaged 1 years and 8 months (range, 8 months to 2 years and 2 months). 2 feet recurred hammer toe deformity. But, this group had no problem to push off action on the forefoot compared with Clayton's operation. As regard the relief of pain, all patients had satisfactory results from both methods. These results clarified that the preservation for the first metatarsophalangeal joint function was superior for push off action on the forefoot.