Lapidus operations corrected the varus position of the first metatarsal and provided stability and pain relief when walking for patients with rheumatoid arthritis, according to study results.
Researchers evaluated 125 patients (average age, 58.5 years; 120 women) with rheumatoid arthritis (RA) who underwent 143 Lapidus operations between 2004 and 2010. Patients presented hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal (MTT) with the intermetarsal angle greater than 15 degrees on anteroposterior weight-bearing X-ray. Signs and symptoms of first MTT instability were detected in 92 feet (64.3%). Two Kirschner wires, two screws or two staples were used for internal fixation.
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Patients had American Orthopaedic Foot and Ankle Society scores of 48.6 before the procedure that improved 6 months after surgery to 87.6. The mean intermetatarsal angle was 24 degrees when measured by X-ray before reconstruction and 11 degrees at 6-month follow-up. Delayed wound healing of 21 days occurred in 15 cases (10.5%). X-rays revealed that seven cases (4.9%) experienced nonunion of the medial cuneometatarsal joint arthrodesis.
Because of comprehensive affliction of patients’ feet, procedural outcomes could not be measured accurately, the researchers said.
“Deformities of the great toe and forefoot are very frequent in patients with rheumatoid arthritis,” the researchers said. “The Lapidus operation allows correction of the varus deformity of the first MTT, thus correcting the valgus position of the great toe and ensuring sufficient stability of the first ray. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in cases of the first metatarsal bone hypermobility.”