A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis

Hideki Ohashi, Keiichiro Nishida, Yoshihisa Nasu, Kenta Saiga, Ryuichi Nakahara, Masahiro Horita, Shunji Okita and Toshifumi Ozaki
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Hideki Ohashi: Department of Orthopaedic Surgery, Takahashi Central Hospital, Okayama 716-0033, Japan
Keiichiro Nishida: Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Yoshihisa Nasu: Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
Kenta Saiga: Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
Ryuichi Nakahara: Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan
Masahiro Horita: Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Shunji Okita: Department of Orthopaedic Surgery, Okayama City Hospital, Okayama 700-0962, Japan
Toshifumi Ozaki: Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan

IJERPH, 2021, vol. 18, issue 14, 1-13

Abstract: Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (?0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ? MOD < 5 mm; grade 2, 5 ? MOD < 10 mm; and grade 3, MOD ? 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

Keywords: lesser toe; metatarsophalangeal joint; rheumatoid arthritis; radiographic measurement; grading system (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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