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Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity
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Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 18670

Special Issue Editors

Prof. Dr. Koichiro Yano

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Guest Editor
Department of Orthopedic surgery, Institute of Rheumatology, Tokyo Women’s Medical University, 8-1 Kawada, Shinjuku, 162-8666 Tokyo, Japan
Interests: rheumatoid arthritis; orthopedic surgery; foot and ankle; footcare; orthosis; total ankle arthroplasty
Prof. Dr. Katsunori Ikari

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, Division of Multidisciplinary Management of Rheumatic Diseases,Tokyo Women's Medical University, 8-1 Kawada, Shinjuku, 162-8666 Tokyo, Japan
Interests: rheumatoid arthritis; orthopedic surgery; foot and ankle surgery; genetics

Special Issue Information

Rheumatoid arthritis (RA) is a systemic and inflammatory autoimmune disease that can cause many health problems and can damage multiple joints throughout the body. In particular, foot joint disorders are major issues for patients with RA, as more than 90% of patients with RA report foot symptoms at some time during the course of their disease. In the past several decades, the introduction of powerful and effective antirheumatic drugs (including molecularly targeted drugs) and the progression of treatment strategies have dramatically improved the disease activity of RA. As a result, a large proportion of patients with RA achieve low disease activity and have reduced progression of joint destruction. However, the proportion of patients with current symptoms and deformities in the foot joints is still high. The foot is a very important part of our body which assists our basic function of walking. Foot health problems eventually lead to poor quality of life and daily activity. When conservative therapies for forefoot deformities in patients with RA fail, surgical procedures are considered. Recently, the surgical methods for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery.

We are organizing a Special Issue on the impact of joint-preserving surgeries for rheumatoid forefoot deformities in the International Journal of Environmental Research and Public Health. There are many procedures to preserve joints, including various types of osteotomy and soft tissue reconstruction. This Special Issue aims to provide detailed surgical techniques and the outcomes of each procedure. We hope that surgeons can choose the optimum surgical methods from this Special Issue to achieve the best practice and restore foot health.

Prof. Dr. Koichiro Yano
Prof. Dr. Katsunori Ikari
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • foot
  • forefoot
  • health assessment questionnaire
  • joint-preserving surgery
  • metatarsal
  • molecularly targeted drugs
  • rheumatoid arthritis

Published Papers (7 papers)

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Editorial

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3 pages, 235 KiB  
Editorial
Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity: An Editorial
by Koichiro Yano and Katsunori Ikari
Int. J. Environ. Res. Public Health 2022, 19(4), 2038; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042038 - 11 Feb 2022
Viewed by 1107
Abstract
In the past few decades, physicians have been able to effectively manage patients with rheumatoid arthritis (RA) thanks to advances in treatment strategies including molecular-targeting drugs [...] Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)

Research

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10 pages, 4160 KiB  
Article
Forefoot Deformities in Patients with Rheumatoid Arthritis: Mid- to Long-Term Result of Joint-Preserving Surgery in Comparison with Resection Arthroplasty
by Yuya Takakubo, Yoshihiro Wanezaki, Hiroharu Oki, Yasushi Naganuma, Junichiro Shibuya, Ryusuke Honma, Akemi Suzuki, Hiroshi Satake and Michiaki Takagi
Int. J. Environ. Res. Public Health 2021, 18(21), 11257; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111257 - 26 Oct 2021
Cited by 3 | Viewed by 2269
Abstract
Background: Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot. Methods: Forefoot surgeries were performed on 62 toes in 42 patients with RA (men: 2; women: 40) [...] Read more.
Background: Joint-preserving surgery for the forefoot has been increasingly performed for rheumatoid arthritis (RA). We compared joint-preserving surgeries with resection arthroplasty for RA in the forefoot. Methods: Forefoot surgeries were performed on 62 toes in 42 patients with RA (men: 2; women: 40) between 2002 and 2018. Three groups were compared: PP—31 toes treated with joint-preserving surgery involving the modified Mann method for the big toe and offset osteotomy for lesser toes, PR—15 toes treated with joint-preserving surgery for the big toe and resection arthroplasty for lesser toes, and RR—16 toes treated with resection arthroplasty for all the toes. Results: The PP group had significantly higher mean scores on a scale for RA in the foot and ankle at the latest follow-up than the RR group (86 vs. 75 points; p < 0.05). Hallux valgus (angle > 20°) of the big toe at the latest follow-up recurred in 10 (32%), 9 (60%), and 16 (100%) patients in the PP, PR, and RR groups, respectively. A revision surgery was performed in one patient each in the PP and PR groups. Conclusions: Joint-preserving surgery is superior to resection arthroplasty in preventing function loss and the recurrence of hallux valgus. Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)
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13 pages, 744 KiB  
Article
Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis
by Takumi Matsumoto, Yuji Maenohara, Song Ho Chang, Kumiko Ono, Yasunori Omata, Jun Hirose and Sakae Tanaka
Int. J. Environ. Res. Public Health 2021, 18(20), 10667; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182010667 - 12 Oct 2021
Cited by 3 | Viewed by 4425
Abstract
Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who [...] Read more.
Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release. Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)
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9 pages, 535 KiB  
Article
Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity
by 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
Int. J. Environ. Res. Public Health 2021, 18(19), 10473; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910473 - 05 Oct 2021
Cited by 5 | Viewed by 2702
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)
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11 pages, 1613 KiB  
Article
The Combination of Modified Mitchell’s Osteotomy and Shortening Oblique Osteotomy for Patients with Rheumatoid Arthritis: An Analysis of Changes in Plantar Pressure Distribution
by Hyunho Lee, Hajime Ishikawa, Tatsuaki Shibuya, Chinatsu Takai, Tetsuya Nemoto, Yumi Nomura, Asami Abe, Hiroshi Otani, Satoshi Ito, Kiyoshi Nakazono, Kaoru Abe, Kazuyoshi Nakanishi and Akira Murasawa
Int. J. Environ. Res. Public Health 2021, 18(19), 9948; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18199948 - 22 Sep 2021
Cited by 6 | Viewed by 1608
Abstract
The present study aims to evaluate changes in plantar pressure distribution after joint-preserving surgery for rheumatoid forefoot deformity. A retrospective study was performed on 26 feet of 23 patients with rheumatoid arthritis (RA) who underwent the following surgical combination: modified Mitchell’s osteotomy (mMO) [...] Read more.
The present study aims to evaluate changes in plantar pressure distribution after joint-preserving surgery for rheumatoid forefoot deformity. A retrospective study was performed on 26 feet of 23 patients with rheumatoid arthritis (RA) who underwent the following surgical combination: modified Mitchell’s osteotomy (mMO) of the first metatarsal and shortening oblique osteotomy of the lateral four metatarsals. Plantar pressure distribution and clinical background parameters were evaluated preoperatively and one year postoperatively. A comparison of preoperative and postoperative values indicated a significant improvement in the visual analog scale, Japanese Society for Surgery of the Foot scale, and radiographic parameters, such as the hallux valgus angle. A significant increase in peak pressure was observed at the first metatarsophalangeal joint (MTPJ) (0.045 vs. 0.082 kg/cm2; p < 0.05) and a significant decrease at the second and third MTPJs (0.081 vs. 0.048 kg/cm2; p < 0.05, 0.097 vs. 0.054 kg/cm2; p < 0.05). While overloading at the lateral metatarsal heads following mMO has been reported in previous studies, no increase in peak pressure at the lateral MTPJs was observed in our study. The results of our study show that this surgical combination can be an effective and beneficial surgical combination for RA patients with mild to moderate joint deformity. Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)
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13 pages, 5646 KiB  
Article
A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis
by Hideki Ohashi, Keiichiro Nishida, Yoshihisa Nasu, Kenta Saiga, Ryuichi Nakahara, Masahiro Horita, Shunji Okita and Toshifumi Ozaki
Int. J. Environ. Res. Public Health 2021, 18(14), 7520; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147520 - 15 Jul 2021
Cited by 1 | Viewed by 1903
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)
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Review

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13 pages, 2157 KiB  
Review
Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review
by Koichiro Yano, Katsunori Ikari, Haruki Tobimatsu, Ayako Tominaga and Ken Okazaki
Int. J. Environ. Res. Public Health 2021, 18(8), 4093; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084093 - 13 Apr 2021
Cited by 10 | Viewed by 3454
Abstract
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical [...] Read more.
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review. Full article
(This article belongs to the Special Issue Outcomes of Joint-Preserving Surgery for Rheumatoid Forefoot Deformity)
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