The foot is commonly involved in rheumatoid arthritis and the deformities are often multiple and severe. They frequently include pes planus, splay foot, hallux valgus, clawing of the toes, and subluxation of the toes at the MP joints. Anterior metatarsalgia is often marked. Sometimes a single deformity, such as a hammer toe, may be the main source of the patient's symptoms and may be amenable to a simple local surgical procedure. Where there are many deformities, the prescription of surgical shoes with moulded insoles may be the best treatment. Where there is gross crippling deformity, Fowler's operation, which is an arthroplasty of all the metatarsophalangeal joints combined with a plastic reconstruction of the metatarsal weightbearing pad. is often helpful in older patients; the best results may be obtained when the procedure is combined with fusion of the first MP joint.
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