A new retrospective study evaluated 74 feet in 57 rheumatoid arthritis patients with severe hallux valgus (HV) deformity (Larsen grade ≥3), comparing first metatarsophalangeal (MTP) joint arthrodesis (27 feet) and joint-preserving surgery (47 feet). Procedures were performed at Japan’s Kyushu University Hospital between 2008 and 2022. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) Hallux scale and radiographic HV angle (HVA). After propensity score matching, both groups showed significant functional improvement postoperatively. The arthrodesis group had a longer mean follow-up (5.1 ± 2.6 years) than the joint-preserving group (2.4 ± 2.0 years, P < 0.01).
All patients undergoing arthrodesis also received resection arthroplasty on the second to fifth toes. In the joint-preserving group, procedures varied: 5 involved only first MTP surgery, while 42 included additional lesser toe procedures. Joint-preserving surgery yielded significant JSSF scores compared to arthrodesis (preoperative: 22±1 vs 17±8, P=0.01), although both had comparable outcomes in foot function over time. A subgroup analysis using propensity score matching performed in 38 feet of 32 patients revealed a significantly greater improvement in the functional scores in the joint-preserving group (32±6 vs 28±8, P=0.04). Recurrence of deformity was associated with higher immediate postoperative HVA. The findings suggest that joint-preserving surgery can provide greater functional benefit than arthrodesis, even in advanced joint destruction, making it a viable alternative in treating severe RA-related forefoot deformities.
Source: Sakai S, Fujiwara T, Yamaguchi R, et al. First metatarsophalangeal joint-preserving surgery is effective for forefoot deformity with moderate to severe joint destruction in rheumatoid arthritis. Foot Ankle Ortho. 2025;10(1). doi:10.1177/24730114251322790.
