Arthrodesis of the first metatarsophalangeal (MTP) joint has been recommended for severe hallux valgus deformity in patients with rheumatoid arthritis. We developed an alternative procedure that preserves motion of the first MTP joint while restoring alignment and balance to the forefoot. This procedure was shown to be effective in a series of 60 patients with a 3-year follow-up.
We perform a modified Scarf osteotomy, with the longitudinal first metatarsal cut parallel to the sole of the foot and with shortening of the metatarsal to realign the first ray. This is combined with an interpositional capsular arthroplasty of the first MTP joint and shortening offset osteotomies of the lesser metatarsals.
Alternatives include arthrodesis of the first MTP joint combined with resection arthroplasty of the lesser MTP joints, or of all 5 MTP joints, or perhaps interpositional (total) joint arthroplasty for severe rheumatoid forefoot deformity/destruction.
The purpose of the modified Scarf osteotomy is preservation of motion of the first MTP joint and protection against destruction of the rheumatoid joint. The metatarsal shortening offset osteotomy provides rigid stabilization at the site of osteotomy after dynamic correction to make the transverse arch.
1Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan
2Department of Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
3Nampei Orthopaedics and Rheumatology Clinic, Katsuragi, Japan
4Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan
5Department of Orthopaedics, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
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