rheumatoid arthritis foot & ankle

Question 1

rheumatoid arthritis foot deformity
- deformities

Answer 1

FOREFOOT
- Hallux valgus
- lesser toe clawing - intrinsic tightness
- MTPJ dislocation - synovitis - collateral lig incompetence, dorsal subluxation, volar plate attenuation and MTPJ dislocation
- metatarsalgia/ fat pad atroph and callosities - dislocated MTPJ - MT head plantar flexes

HINDFOOT
- planovalgus deformity
- hindfoot valgus
- talonavicular subluxation/ dislocation - causes medial arch flattening and forefoot pronation
- subfibular impingement
- tib post and peroneal tendonitis

Question 2

rheumatoid arthritis foot deformity management

Answer 2

NON-OP management
- orthotics/ injections
- immunosuppressants - methotrexate/ steroids
- DMDs - anti-TNF

OPERATIVE
-1st MTPJ fusion -oblique compression screw and dorsal locking plate
- MT head - Weils osteotomy or excision or stainsby
- PIPJ fusion
- arthrodesis

Stopping medication:
- methotrexate continue
- TNF antags - surgery at end of dose +1 week - restart after 10days
- Anti-IL6 - continue for minor ops and stop 1-2days before for major ops - restart after 10days

Question 3

rheumatoid arthritis foot deformity
- definition

Answer 3

Rheumatoid Arthritis is a chronic systemic autoimmune disease caused by IgM cell-mediated immune response against soft tissues, cartilage, and bone

• IgM binding results in deposition of immune complexes and activation of an inflammatory cascade mediated by IL-1, IL-6 and TNFalpha