Surgical correction of the rheumatoid forefoot by the Lelièvre procedure

Summary From January 1986 to December 1990 we treated 57 patients with deformed forefeet due to rheumatoid arthritis. In 70 cases (13 patients on both sides) surgical correction according to the Lelievre procedure was carried out. The outcome of this operation has been analysed in an attempt to find reasons for poor results and the relatively high recurrence rate of hallux valgus. Thirty-one patients were reviewed, i.e. a total of 44 operations at a median follow-up of 5 years and 3 months. The investigation included a subjective, objective and radiological assessment of the outcome of this kind of surgical management. The results showed that 77% of the operated feet by the Lelievre procedure were painfree or had dramatically reduced pain. Patients with persisting complaints had a recurrence of plantar callosities and a distinct fibular shift of toes. Radiologically the failures showed inadequately resected metatarsal heads. We have emphasized a critical evaluation of the metatarsal index. The plus-minus index was associated with a good result, whereas the plus index always went along with a poor result. The Lelievre procedure performed precisely and with a plus-minus metatarsal index can produce very good results and can be recommended for the surgical management of the deformed forefoot due to rheumatoid arthritis.

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