ForefootreconstructionInflammatoryarthritis(suchRheumatoidarthritisandLupus)leadtodeformitiesthataremoresevereanddisablingthanosteoarthritis.Inrelationtotheforefootitcancause1. Severebunions

2. Painfulclawingofthetoes.Theremaybecallusesandcornsonthetoesasaresultofpressureareasandfindingsuitablefootwearisdifficult.Patientsmayalsodescribeafeelingofwalkingonpebblesasthepaddingunderneaththeforefoothasboththinnedoutandbeendraggedawayfromitsnormalspot.

Management:Itisimportanttoobtainweightbearingxraystohelpassessthefunctionalimpactofthedeformity.Nonsurgicaltreatment:

• Referraltoanorthotistand/orpodiatristtoassistwithofmodificationtofootwearwithawideranddeepertoeboxaswellasanorthosis(insole)thatcanoffloadtheareathatfeelslikepebbles.

• Yourrheumatologistwillassistwithensuringyouareontheright“diseasemodifying”agentssoastolimittheprogressionofthediseaseandtoassistwithmanagementofmedicationinthe“perioperative”period.

Surgicalmanagementisaimedatstraighteningyourfoottoaccommodatenormalfootwearandallowpainlesswalking.Thisoftenmeansasmallamountofshorteningoftheoveralllengthofthefoot.Youmayneedtoseetheanaesthetistsotheycanassessyourfitnessforsurgery.Theoperationtakesupto3hoursespeciallyifbothsidesareareoperatedonatthesametime,andyouwillneed1-3nightsinhospital.YouwilllikelyrequireafusionofyourbigtoewhichusuallyeliminatesthebunionInadditiontostraighteningoftheclawdeformitiesintheformofeithera“Stainsby”or“Fowler”procedure.Youwillhavewires(protected)protrudingfromtheendsofyourtoesfor6weeksandrequirespecialopenfootwearduringthistime.Youwillbeallowedtoweightbearaftertheprocedurebutitisimportanttospendasmuchtimeaspossiblewiththeoperatedfootstrictlyelevatedabovethelevelofyourheart.

Youwillbereviewedat2weekspostsurgerytoassessthewoundhealingprocesswhichissomethingthatmustbetakenveryseriously.Otherpotentialcomplicationsinclude:infection,lossofbloodsupplytothetoes,failuretoresolvesymptoms.Theriskswillbefurtherdiscussedattimeofconsentforsurgery.Swellingandpaincanbeanissueforup3-12months.