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Long-Term Results of the Modified Hoffman Procedure in the Rheumatoid Forefoot

Thomas, S. MBChB, BSc, MRCS; Kinninmonth, A.W.G. MB, FRCS(Ed)Orth; Kumar, C. Senthil FRCS(Tr & Orth)

Journal of Bone & Joint Surgery - American Volume: April 2005 - Volume 87 - Issue 4 - p 748–752
doi: 10.2106/JBJS.C.01696
Scientific Articles

Background: Rheumatoid arthritis commonly affects the forefoot, causing metatarsalgia, hallux valgus, and deformities of the lesser toes. Various types of surgical correction have been described, including resection of the lesser-toe metatarsal heads coupled with arthrodesis of the great toe, resection arthroplasty of the proximal phalanx or metatarsal head, and metatarsal osteotomy. We report the results at an average of five and a half years following thirty-seven consecutive forefoot arthroplasties performed in twenty patients by one surgeon using a technique involving resection of all five metatarsal heads.

Methods: All patients were treated with the same technique of resection of all five metatarsal heads through three dorsal incisions. All surviving patients were asked to return for follow-up, which included subjective assessment (with use of visual analogue pain scores, AOFAS [American Orthopaedic Foot and Ankle Society] foot scores, and SF-12 [Short Form-12] mental and physical disability scores), physical examination, and radiographic evaluation.

Results: All results were satisfactory to excellent in the short term (six weeks postoperatively), and no patient sought additional surgical treatment for the feet. A superficial infection subsequently developed in two feet, and two feet had delayed wound-healing. At an average of 64.9 months postoperatively, the average AOFAS forefoot score was 64.5 points and the average hallux valgus angle was 22.3°. There were no reoperations.

Conclusions: Resection of all five metatarsal heads in patients with metatarsalgia and hallux valgus associated with rheumatoid arthritis can be a safe procedure that provides reasonable, if rarely complete, relief of symptoms.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

1 Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee DD1 9SY, United Kingdom. E-mail address for S. Thomas: simon_thomas97@hotmail.com

2 Department of Orthopaedics, Golden Jubilee National Hospital, Beardmore Street, Clydebank G81 4HX, United Kingdom

3 Department of Orthopaedic and Trauma Surgery, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom

Copyright 2005 by The Journal of Bone and Joint Surgery, Incorporated
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