Rheumatoid forefoot reconstruction
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The most commonly used combination of surgical procedures for the symptomatic Rheumatoid forefoot (though many alternatives have been described) is a corrective fusion of the 1st MTP, excision of the lesser metatarsal heads and osteoclasis (closed corrective fracturing) of lesser toe deformities, stabilised with K wire fixation.
The results are dramatic and usually transformatory but the soft tissues not infrequently are slow to heal.
Holistic management of these patients is important and requires considering all other joints involved as well as careful management of any disease modifying medications in the peri-operative period.
Author: Mark Herron FRCS.
Institution: The Wellington Hospital, London.