Vol.23 No.5

Original Article

Proximal rotational closing-wedge osteotomy of the first metatarsal in rheumatoid arthritis: clinical and radiographic evaluation of a continuous series of 35 cases

Authors

Koichiro Yano¹ , Katsunori Ikari¹ , Takuji Iwamoto¹ , Asami Saito¹ , Yurino Naito¹ , Kosei Kawakami¹ , Taku Suzuki¹ , Hitoshi Imamura¹ , Yu Sakuma¹ , Ryo Hiroshima¹ , Shigeki Momohara¹

Received:

10 July 2012

Accepted:

20 September 2012

Published online:

16 October 2012

Full Text

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Abstract

Objectives The introduction of powerful antirheumatic
drugs has dramatically improved the treatment of rheumatoid
arthritis (RA), leading clinicians to reconsider the
benefits of joint preservation for rheumatoid forefoot
deformities. We have employed joint-preserving forefoot
surgeries, including rotational closing-wedge osteotomy of
the first metatarsal. The aim of our study is to assess the
short-term results of this procedure.
Methods From January 2011 through December 2011, 35
feet were treated with this procedure. Subjective, functional,
and radiographic outcomes were surveyed.
Results The mean Japanese Society for Surgery of the
Foot improved from a preoperative level of 52.6 to 68.7
postoperatively. The average hallux valgus and intermetatarsal
angles improved from 47.3 preoperatively to 17.5
postoperatively, and from 16.7 preoperatively to 9.0
postoperatively, respectively. To assess the repositioning of
pronation deformities of the first metatarsal, the position of
the medial sesamoid was also surveyed according to the
measurement system proposed by Hardy and Clapham. All
feet except two were classified as grade V or higher preoperatively;
25 of these were grade IV or lower at the latest
follow-up.
Conclusions Rotational closing-wedge osteotomy of the
first metatarsal was beneficial for correcting forefoot
deformities in RA over the short term.

Key words

Hallux valgus, Joint-preserving surgery, Osteotomy of first metatarsal, Rheumatoid arthritis, Rotational closing-wedge osteotomy