Is a Joint-Preserving Option a Possibility in Rheumatoid Arthritis–Related Hallux Valgus?

Surgeons are well aware of the impact rheumatoid arthritis (RA) has on patients, particularly in the realm of forefoot deformity. A common surgical pathway includes arthrodesis of the first metatarsophalangeal joint for severe cases. However, it is important to acknowledge that fusion is joint destructive, while joint-preserving surgery could potentially maintain some mobility, per the authors of a recent study.¹ The authors investigated outcomes related to the distal chevron metatarsal osteotomy (DCMO) when correcting hallux valgus deformity associated with RA.¹

Over a more than 8-year period, the authors looked at 18 consecutive patients with rheumatoid forefoot deformities (24 feet) who underwent DCMO for hallux valgus. Some cases also included lesser toe surgery. Radiological evaluation analyzed the hallux valgus angle, the first-second intermetatarsal angle, and the Sharp/van der Heijde score for erosion and joint space narrowing.¹ The authors used both the Clinical visual analog scale for pain characterization and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores.¹

At final follow-up, the authors noted that the mean hallux valgus angle decreased from 38.0° preoperatively to 3.5°. The mean intermetatarsal angle went from 14.9° to 4.3°. The mean erosion score did not exhibit a notable change. Recurrence took place in one case, spontaneous fusion in one case, and postop hallux varus developed in 2 cases.¹

Overall, the authors on this study feel that DCMO provided satisfactory outcomes, both clinical and radiographic, when undertaking correction for RA-associated hallux valgus deformities.¹

Reference
1.     Park SH, Choi YR, Lee J, Doh CH, Lee HS. Joint-preserving surgery for hallux valgus deformity in rheumatoid arthritis. Clin Orthop Surg. 2024 Jun;16(3):461-469. doi: 10.4055/cios23184. Epub 2024 Apr 25. PMID: 38827764; PMCID: PMC11130625.