MANN-THOMPSON PROCEDURE FOR RHEUMATOID FOREFOOT DISEASE – MEDIUM TERM RESULTS

Abstract

We present our results with a modified Mann-Thompson procedure in 47 patients (86 feet). Minimum follow up was 24 months.

All patients had moderate to advanced forefoot deformities.

Methods:

• M:F=12:35

• 43/47 bilateral

• Simultaneous procedures in bilateral cases.

• Popliteal block analgesia used routinely.

Technique:

• Medial incision centered on MTP1 joint. Minimal bony and soft tissue resection. Fixation carried out with staples (78 feet),K-wires (8 feet)

• Transverse incision centered on the lesser MTP joints made. Combination of soft tissue release, lesser MT head resection in cascade fashion from dorsal distal to proximal plantar performed. Lesser toe deformities treated by a combination of closed osteoclasis, soft tissue release and bony resection. Transarticular K-wire fixation then performed for all lesser toes.

• Bulky postop dressing and post op shoes used.

• Immediate FWB permitted.

• Transarticular K-wires removed at 4/52.

Results:

• AOFAS Forefoot Scores assessed at preop,6/12,12/ 12,and24/12.

• Subjective patient assessment of procedure requested.

• Average AOFAS scores improved from 37to72(67 – 84)

• 40 patients extremely pleased with the results. 5 patients pleased with reservations and 2 patients disappointed with the outcome.

Complications:

• 3 superficial wound infections

• 2 metal work related problems

• 2 early loss of lesser toe correction

• 3 late deformities of lesser metatarsals requiring surgery

Conclusion: This procedure offers excellent, reproducible biomechanical correction with high rates of patient satisfaction.