ForefootreconstructionInflammatoryarthritis(suchRheumatoidarthritisandLupus)leadtodeformitiesthataremoresevereanddisablingthanosteoarthritis.Inrelationtotheforefootitcancause1. Severebunions
2. Painfulclawingofthetoes.Theremaybecallusesandcornsonthetoesasaresultofpressureareasandfindingsuitablefootwearisdifficult.Patientsmayalsodescribeafeelingofwalkingonpebblesasthepaddingunderneaththeforefoothasboththinnedoutandbeendraggedawayfromitsnormalspot.
Management:Itisimportanttoobtainweightbearingxraystohelpassessthefunctionalimpactofthedeformity.Nonsurgicaltreatment:
• Referraltoanorthotistand/orpodiatristtoassistwithofmodificationtofootwearwithawideranddeepertoeboxaswellasanorthosis(insole)thatcanoffloadtheareathatfeelslikepebbles.
• Yourrheumatologistwillassistwithensuringyouareontheright“diseasemodifying”agentssoastolimittheprogressionofthediseaseandtoassistwithmanagementofmedicationinthe“perioperative”period.
Surgicalmanagementisaimedatstraighteningyourfoottoaccommodatenormalfootwearandallowpainlesswalking.Thisoftenmeansasmallamountofshorteningoftheoveralllengthofthefoot.Youmayneedtoseetheanaesthetistsotheycanassessyourfitnessforsurgery.Theoperationtakesupto3hoursespeciallyifbothsidesareareoperatedonatthesametime,andyouwillneed1-3nightsinhospital.YouwilllikelyrequireafusionofyourbigtoewhichusuallyeliminatesthebunionInadditiontostraighteningoftheclawdeformitiesintheformofeithera“Stainsby”or“Fowler”procedure.Youwillhavewires(protected)protrudingfromtheendsofyourtoesfor6weeksandrequirespecialopenfootwearduringthistime.Youwillbeallowedtoweightbearaftertheprocedurebutitisimportanttospendasmuchtimeaspossiblewiththeoperatedfootstrictlyelevatedabovethelevelofyourheart.
Youwillbereviewedat2weekspostsurgerytoassessthewoundhealingprocesswhichissomethingthatmustbetakenveryseriously.Otherpotentialcomplicationsinclude:infection,lossofbloodsupplytothetoes,failuretoresolvesymptoms.Theriskswillbefurtherdiscussedattimeofconsentforsurgery.Swellingandpaincanbeanissueforup3-12months.