Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

Yuki Etani, Makoto Hirao, Kosuke Ebina, Takaaki Noguchi, Gensuke Okamura, Akira Miyama, Hideki Tsuboi, Akihide Nampei, Shigeyoshi Tsuji, Hajime Owaki, Seiji Okada and Jun Hashimoto
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Yuki Etani: Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
Makoto Hirao: Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
Kosuke Ebina: Department of Musculoskeletal Regenerative Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
Takaaki Noguchi: Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan
Gensuke Okamura: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai 591-8025, Japan
Akira Miyama: Department of Orthopaedic Surgery, National Hospital Organization, Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan
Hideki Tsuboi: Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai 591-8025, Japan
Akihide Nampei: Nampei Orthopaedics and Rheumatology Clinic, Katsuragi 639-2162, Japan
Shigeyoshi Tsuji: Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan
Hajime Owaki: Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Osaka Hospital, Osaka 553-0003, Japan
Seiji Okada: Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan
Jun Hashimoto: Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan

IJERPH, 2021, vol. 18, issue 19, 1-9

Abstract: With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.

Keywords: rheumatoid arthritis; forefoot deformity; modified scarf osteotomy; metatarsal shortening offset osteotomy; disease activity; intermetatarsal angle between the 2nd and 5th metatarsal bones (M2-M5A) (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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