Rheumatoid foot reconstruction for Rheumatoid arthritis

What is rheumatoid foot reconstruction?

Rheumatoid forefoot reconstruction is an operation for patients who have severe toe deformities due to rheumatoid arthritis. These deformities can cause pain and difficulty walking.

Rheumatoid arthritis is a more severe form of arthritis, when the body’s immune system is actually attacking and destroying the joints, causing pain and swelling.

Before any surgery is carried out the whole patient should be assessed with an emphasis on their medical management as well as surgery. Any reconstruction in the forefoot is individualised to take account of the patient’s exact symptoms and problems as no two rheumatoid feet are the same. The procedure may involve either surgery to the great toe or the lesser toes or some combination of the two.

The operation is usually carried out under general anaesthetic, and can either be a day-case procedure or sometimes an overnight stay in hospital.

An incision is made on the side of the big toe, the arthritic joint is removed and the bones are either held in place with screws and sometimes a small plate, alternatively a large bunion can simply be removed. To help relieve the pain on the ball of the foot the toe deformities are then corrected. This often involves moving small amounts of bone from the toes and can be performed using cuts either on the top or the sole of the foot, alternatively for lesser deformities the soft tissues may be reconstructed.

Following the operation, you will be placed in a bandage with a rigid strip of plaster on the side if a toe fusion has been performed.

What are the risks?

Any surgical intervention has potential risks of complications, such as pain, excessive bleeding, and infection in the surgical wound, unsightly scarring, blood clotting.

This procedure has a minor risk of complications such as plaster problems and damage to the nerves of the toe.  There will also be significant swelling after the surgery, and how quickly the swelling disappears depends from person to person.

For cases of severe deformity it might not be possible to obtain a complete correction. All risks will be discussed in full with the consultant.

How soon will I recover?

You will probably be kept overnight to allow the swelling to go down.  Your recovery depends on your overall health and mobility.

A plaster or firm bandage will be required for the first 2 weeks but you should be able to walk on your heel straight away. Once your bandage and stitches will be removed you might be required to wear a splinter or plaster.  Keep your leg elevated as much as possible.

As soon as splinter or plaster will be removed you can start light exercises and walking more. Your consultant or physiotherapist will advise you about what type of exercises you should do and what to expect from the recovery period.

*Revised and updated November 2016

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