Abstract
Introduction
Excision of prominent metatarsal heads for severe rheumatoid forefoot deformity is well established in clinical practice but results may deteriorate with time. The Stainsby forefoot arthroplasty however, recognises the pathological anatomy of the deformity and is designed to preserve the metatarsal heads by repositioning the plantar plates and forefoot fat pad underneath them.
Design
A prospective case series observing the clinical outcomes and changes in pedobarograph patterns in rheumatoid arthritis patients with severe deformity undergoing Stainsby forefoot arthroplasty.
Materials and methods
Twelve patients (21 operated feet) were reviewed at 5 years. AOFAS scores and pedobarographs were recorded pre-operatively and at 5 years post-operatively.
Results
AOFAS scores improved significantly from 21 ± 15 pre-operatively to 61 ± 12 at 5 years (p<0.0001) with most of the improvement occurring in the pain score.
Pre-operative pedobarographs showed a concentration of forefoot loading, either under the 1st metatarsal or metatarsals 2 and 3, in 38% of patients. Post-operatively there was a significant reduction of peak loading under the 1st metatarsal and metatarsals 2 and 3 and a more even distribution of loading under the forefoot.
The duration of the forefoot stance phase as a percentage of total stance phase improved from 24% pre-operatively to 31% post-operatively.
Conclusions
Patient reported outcomes indicate the Stainsby procedure provides increased function and lasting pain relief. This is further supported by pedobarograph data showing improvement in the pressure distribution and stance times during gait. We therefore recommend this procedure for management of severe rheumatoid forefoot deformity.
