forefoot reconstruction - orthopaedic associates …forefoot reconstruction inflammatory arthritis...

Forefoot reconstruction Inflammatory arthritis (such Rheumatoid arthritis and Lupus) lead to deformities that are more severe and disabling than osteoarthritis. In relation to the forefoot it can cause 1. Severe bunions 2. Painful clawing of the toes. There may be calluses and corns on the toes as a result of pressure areas and finding suitable footwear is difficult. Patients may also describe a feeling of walking on pebbles as the padding underneath the forefoot has both thinned out and been dragged away from its normal spot.

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Page 1: Forefoot reconstruction - Orthopaedic Associates …Forefoot reconstruction Inflammatory arthritis (such Rheumatoid arthritis and Lupus) lead to deformities that are more severe and

ForefootreconstructionInflammatoryarthritis(suchRheumatoidarthritisandLupus)leadtodeformitiesthataremoresevereanddisablingthanosteoarthritis.Inrelationtotheforefootitcancause1. Severebunions

2. Painfulclawingofthetoes.Theremaybecallusesandcornsonthetoesasaresultofpressureareasandfindingsuitablefootwearisdifficult.Patientsmayalsodescribeafeelingofwalkingonpebblesasthepaddingunderneaththeforefoothasboththinnedoutandbeendraggedawayfromitsnormalspot.

Page 2: Forefoot reconstruction - Orthopaedic Associates …Forefoot reconstruction Inflammatory arthritis (such Rheumatoid arthritis and Lupus) lead to deformities that are more severe and

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.

Page 3: Forefoot reconstruction - Orthopaedic Associates …Forefoot reconstruction Inflammatory arthritis (such Rheumatoid arthritis and Lupus) lead to deformities that are more severe and

Youwillbereviewedat2weekspostsurgerytoassessthewoundhealingprocesswhichissomethingthatmustbetakenveryseriously.Otherpotentialcomplicationsinclude:infection,lossofbloodsupplytothetoes,failuretoresolvesymptoms.Theriskswillbefurtherdiscussedattimeofconsentforsurgery.Swellingandpaincanbeanissueforup3-12months.

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