what are some typical forefoot deformities seen in RA?
- hyperpronation
- metatarsalgia
- MPJ dislocation
- hallux valgus
- claw toes
- hammer toes
what are some typical midfoot and rearfoot deformities seen with RA?
- TN arthritis
- STJ arthritis
- rupture of PTT
what are non-operative treatment options for RA?
- pharmacologic: NSAIDs, DMARDs, corticosteroids
- accommodative insoles
- AFO
- shoegear modifications: rocker bottom sole
what are the goals for surger y in a RA patient?
- pain relief
- improvement of overall function
- correction of deformity by increasing stability and overall muscle force
what is peri-op management of RA patients?
if 5mg, give regular dose + 25mg prior to srugery
do you stop DMARDs prior to surgery?
yes, stop 1-2 wks prior to sx
true or false: methotrexate DOES NOT need to be stopped prior to surgery
true
what other peri-op mgmt do you worry about for RA patient?
- prophylactic abx
- prophylaxis for DVT
- workup for atlantoaxial subluxation
- overall bone stock
what is a panmetatarsal head resection?
taking out met heads 2-5 followed with 1st MPJ arthroplasty or arthrodesis
which incisional approach for pan-met head resection is a plantar transverse incision?
Hoffman
which incisional approach for pan-met head resection is a three dorsal linear incision?
Larmon
which incisional approach for pan-met head resection is a 5-dorsal linear incision?
Hodor and Dobbs
which incisional approach for pan-met head resection is a dorsal longitudinal incision?
McKeever
which incisional approach for pan-met head resection is a dorsal transverse incision?
Clayton
which incisional approach for pan-met head resection is a one linear, two lazy S procedures?
Bilotti
what are advantages of pan met head resection?
- eliminates painful MPJs
- ability to ambulate w/o pain
- allows patient to wear regular shoes
- allows reduction of dorsally contracted digits
- elimination of plantar pressure points
what is the Mayo arthroplasty technique?
resection of 1st met head
not used anymore
what is the Keller arthroplasty?
resection of base of prox. phalanx
which procedure is good for osteopenic bone?
arthroplasty
if you have good bone stock, what procedure should you do?
arthrodesis
if patient has hindfoot arthritis, what should you do?
triple arthrodesis- fusion of TN, STJ, CC
if patient has ankle arthritis, what should you do?
total ankle arthroplasty
ankle arthodesis
