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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 7, 914-919.
doi: 10.1302/0301-620X.88B7.17472  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Arthrodesis versus Mayo resection

THE MANAGEMENT OF THE FIRST METATARSOPHALANGEAL JOINT IN RECONSTRUCTION OF THE RHEUMATOID FOREFOOT

L. Grondal, MD, Orthopaedic Surgeon1; E. Broström, PT, PhD, Research Physiotherapist2; P. Wretenberg, MD, PhD, Consultant Orthopaedic Surgeon3; and A. Stark, MD, PhD, Consultant Orthopaedic Surgeon3

1 Department of Molecular Medicine and Surgery, Karolinska Institute, Red Cross Hospital, Brinellvägen 2, S-114 28 Stockholm, Sweden.
2 Department of Woman and Child Health
3 Department of Molecular Medicine and Surgery, Section of Orthopaedics, Karolinska Institute, Karolinska University Hospital, S-117 76 Stockholm, Sweden.

Correspondence should be sent to Dr L. Grondal; e-mail: lollo.grondal{at}hospital.redcrosss.se

In a prospective randomised study 31 patients were allocated to either arthrodesis or Mayo resection of the first metatarsophalangeal joint as part of a total reconstruction of the rheumatoid forefoot. Of these, 29 were re-examined after a mean of 72 months (57 to 80), the Foot Function Index was scored and any deformity measured. Load distribution was analysed using a Fscan mat in 14 cases, and time and distance were measured in 12 of these patients using a 3D Motion system. We found excellent patient satisfaction and a significant, lasting reduction of the Foot Function Index, with no statistically significant differences between the groups. There were no significant differences in recurrence of the deformity, the need for special shoes, gait velocity, step length, plantar moment, mean pressure or the position of the centre of force under the forefoot. The cadence was higher and the stance phase shorter in the fusion group.

These results suggest that a Mayo resection may be an equally good option for managing the first metatarsophalangeal joint in reconstruction of the rheumatoid forefoot.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General