Rheumatoid Forefoot Repair

The Problem

Rheumatoid arthritis causes your joints to become swollen and inflamed. Different people have different groups of joints that are involved. Sometimes, the small joints at the base of the toes are attacked by the disease, and after many years the bones can be partly eaten away and the ligaments that hold the toes straight are stretched.

When this happens, your toes can stick up, curl and bend to either side. The fat that normally cushions the ball of your foot gets pulled out of the way with the toes. This leaves nothing but skin between the bones that firm the ball of the foot and floor, and you can get very painful callouses.

The Surgery

Because the problem occurs over many years, your skin gets too tight to simply pull the toes back out into position and hold them there. Even if we could, the joints have usually been destroyed by the rheumatoid arthritis and would be painful. Instead, we take out the ends of the long bones that pass down to make up the ball of the foot. This shortens the foot up a little, but most people don’t notice the difference. Most importantly, it lets the fat fall back into place and cushion the ball of your foot again.

At the same time, we straighten out your small toes and put pins in them to hold them in place while scar tissue forms. Often we have to take out one of the small joints in each toe to do this. Once the toes are healed, they almost always stay straight and are not painful.

Because the big toe takes more stress than the others, we have to make it stiff by fusing the joint at its base (we make the two bones grow together). We use a plate and screws to hold it in place while the bone heals.

Surgery & Recovery

The surgery is done as an outpatient (you do not need to be admitted to the hospital). You will have a tight ACE wrap on after the surgery to control bleeding.

You should take this off 6 hours after the surgery. Leave the bandage underneath in place.

1-3 Days: We have to change your bandage within the first few days and check the incisions. You may walk in a hard-soled shoe we will give you. However, there will be a fair amount of swelling, and you should keep your foot above the level of your heart as much as possible. You can also put ice on the foot for 20 minutes at a time every few hours.

2-3 Weeks: We will take out your stitches.

1 Month: We will take the pins out of the small toes.

2 Months: If your X-rays show the bones in your big toe have fused, you may start wearing regular shoes again. You will have at least one more visit to make sure things are going well.