Long-term results of forefoot arthroplasty in patients with rheumatoid arthritis.

Disabling forefoot deformity of rheumatoid origin frequently requires surgical intervention. Twenty-three patients (36 feet) who underwent excision of the metatarsal heads in our unit between 1980 and 1987 were assessed clinically and radiologically (n = 12) and by questionnaire (n = 11) at an average 10.5 years (range: 4 to 15) following surgery. Although the procedure was initially successful at the time of review, the result was classified as unsatisfactory because of restriction of walking ability due to pain in the forefoot area in 56% of patients. Recurrence of the deformity--more frequently involving the great toe--had occurred in 72% of patients, and painful callosities were present in 61%. In the patients examined clinically and radiologically, unsatisfactory results were due mainly to mal-alignment of the great toe and extensor tendon tightness. Hindfoot deformity also significantly contributed to pain in the forefoot area. Diminished arthroplasty space, irregular resection cascade, and development of bony spikes were frequently associated with recurrence and callosities. The result of forefoot arthroplasty deteriorates with time. Failure to maintain a plantigrade great toe, intrinsic weakness, and hindfoot deformity were the main factors contributing to an unsatisfactory result.