Rheumatoid Forefoot

Deformity 

•  Hallux valgus
•  Lesser toe MTP extension and IP flexion
•  Distal migration of plantar fat pad

When confronted with a hallux valgus deformity, look and ask about RA

 

Non-operative Rx

•  Deep shoe with metatarsal bar and cut outs for prominences

Operative Rx

•  Dwyer procedure
  • 1^st MTP fusion
  •  2-5 MT head excision with interposition of divided extensor tendon
  • 2-5 PIP fusion
• Hoffman
  • Same, without the 1^st MTP fusion