Rheumatoid Forefoot Reconstruction. A Long-Term Follow- up Study* by MICHAEL J. COUGHLIN J Bone...

Rheumatoid Forefoot Reconstruction. A Long-Term Follow-up Study*

by MICHAEL J. COUGHLIN

J Bone Joint Surg AmVolume 82(3):322-41

March 1, 2000

©2000 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 Diagram demonstrating the hallux valgus angle, the first-second intermetatarsal angle, and the MTP-2 angle.

MICHAEL J. COUGHLIN J Bone Joint Surg Am 2000;82:322-41


Fig. 2 Diagram demonstrating the dorsiflexion angle of fusion.



Fig. 3-A Diagram and radiograph demonstrating the medial-lateral position of the lesser metatarsophalangeal joints.



Fig. 3-B Diagram and radiograph demonstrating the medial-lateral position of the lesser metatarsophalangeal joints.



Fig. 4 Diagram demonstrating regular resection of the lesser metatarsals.



Fig. 5-A Preoperative radiograph demonstrating hallux valgus deformity and dislocation of the second, third, and fourth metatarsophalangeal joints.



Fig. 5-B Intraoperative photograph showing the dorsal longitudinal incisions and the dorsal plate used for internal fixation at the site of the arthrodesis of the first metatarsophalangeal joint.



Fig. 5-C: Postoperative radiograph demonstrating arthrodesis of the first metatarsophalangeal joint, resection arthroplasty of the lesser metatarsophalangeal joints, hammer-toe repairs of the

lesser toes, and intramedullary Kirschner-wire fixation.



Fig. 5-D: Radiograph, made at the time of the three-year follow-up, demonstrating anatomical alignment of the lesser metatarsophalangeal joints.



Fig. 5-E Lateral radiograph demonstrating fusion of the first metatarsophalangeal joint.



Fig. 6-A: Radiograph, made five years after an unsuccessful Keller resection arthroplasty, demonstrating fixed dislocation of the lesser metatarsophalangeal joints with hammer-toe

deformities.



Fig. 6-B: Radiograph, made five years and eight months after arthrodeses of the metatarsophalangeal joint and the interphalangeal joint, demonstrating alignment of the lesser

metatarsophalangeal joints.



Fig. 7 Radiograph, made approximately eight years postoperatively, demonstrating successful arthrodesis of the first metatarsophalangeal joint and severe degenerative changes with joint

destruction and subchondral cyst formation (grade-4 arthritis) of the i...



Fig. 8-A: Radiograph, made two years preoperatively, demonstrating severe hallux valgus with dislocation of the first and second metatarsophalangeal joints.



Fig. 8-B: Following arthrodesis, the first metatarsophalangeal joint is realigned.



Rheumatoid Forefoot Reconstruction. A Long-Term Follow- up Study* by MICHAEL J. COUGHLIN J Bone...

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