Rheumatoid foot and ankle reconstruction

Rheumatoid foot and ankle reconstruction

Rheumatoid foot and ankle reconstruction surgery encompasses a variety of techniques to correct damage caused by rheumatoid arthritis of the foot and ankle. Rheumatoid arthritis is a chronic disease that attacks joints all over the body, causing inflammation and debilitating pain. The inflammation can become so severe that it begins to deform the appearance and function of the body parts it affects. It most often begins in the small joints of the hands and feet.

When rheumatoid arthritis affects the foot and ankle, many painful symptoms result. This disease can prevent the lower extremities from functioning properly and hinder walking and balance which, in turn, sets the stage for other painful conditions such as arch collapse, hammer toe, bunions and calluses.

Types

Types of rheumatoid foot and ankle reconstruction surgery include:

  • Rheumatoid ankle reconstruction
    • Fusion – This procedure involves removing the cartilage from the affected joint in the ankle, then aligning the surrounding bones to prepare for fusion with the joint. Metal screws and plates are used to fix the bones together and prevent them from movement as the bones fuse together over time.
    • Ankle replacement – During this type of reconstruction, the surgeon completely removes the damaged ankle joint and reshapes the remaining bones with a surgical tool. The surgeon then inserts an artificial joint to attach to the reshaped bones. Sometimes bone cement is used to hold the bones in place. Metal screws and bone graft are then applied to fuse the bones to the artificial joint in the ankle
  • Rheumatoid hindfoot reconstruction
    • Fusion –This is the most common type of reconstruction surgery to repair the problems associated with rheumatoid arthritis of the foot. Surgery consists of fusing one or more of the three joints in the hindfoot region. If only the subtalar joint is being fused, then one incision will be made on the outside of the foot below the ankle. Double and triple fusion will require an extra incision to be made on the inside of the foot. After the surgeon removes the damaged cartilage and aligns the joints and bones properly, metal screws are inserted to keep the bones in place while they fuse.
  • Rheumatoid midfoot reconstruction
    • Fusion – This is the most common procedure used to reconstruct the bones of the midfoot. The surgery involves fusion of one or more of the joints in the midfoot. Sometimes all of the joints need to be fused together. The surgeon will remove the damaged cartilage, realign the bones properly and insert metal fixations to keep the bones in place as they heal together. There are artificial joint replacement implants that can be used for the outer joints of the midfoot, if applicable.
  • Rheumatoid forefoot reconstruction - When the forefoot section is affected by rheumatoid arthritis, many deformities can result, including bunions, calluses and hammer toe. Common rheumatoid foot reconstruction surgeries used to correct the various complications in the forefoot are:
    • Hoffman procedure – During this procedure, all the metatarsal heads are removed to eliminate the bony bumps caused by hammer toe that have formed on the great toe joint. This surgery is usually combined with fusion (arthrodesis) or arthroplasty to eliminate any complications caused by arthritis.
    • Fusion – The surgeon fuses together one or more of the affected joints in the forefoot region. The damaged cartilage is removed, the bones are realigned and metal fixations are inserted to keep the bones in place while they fuse together.
    • Arthroplasty – The surgeon removes pieces of bone on either side of the middle joint of the rheumatoid toe. This will allow toes suffering from hammer toe to straighten out properly.

The multidisciplinary team of foot and ankle experts at Northwell Health Orthopaedic Institute performs rheumatoid foot and ankle reconstruction as well as a broad range of nonsurgical and surgical treatments for conditions that affect the foot and ankle.

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