Metatarsal shortening offset osteotomy as salvage for painful plantar callosities following resection arthroplasty in patients with rheumatoid arthritis: A report of three cases

Abstract

Surgical treatment for forefoot deformities in patients with rheumatoid arthritis (RA) has recently shifted toward joint-preserving procedures for all toes. In contrast, resection arthroplasty was previously commonly performed for lesser toes. Advances in drug therapy have improved life expectancy, resulting in an increased number of long-term survivors who previously underwent resection arthroplasty. With increased activity levels, recurrence of plantar callosities in the forefoot has become more frequent, often leading to gait disturbance. In general, revision surgery for such cases often involves additional bone resection; however, this approach may result in further shortening of the metatarsals and increase the risk of further recurrence. Therefore, we applied metatarsal shortening offset osteotomy, which we typically perform as a primary procedure, as a salvage procedure to reduce the risk of recurrence. We report three cases treated using this strategy. In all cases, the second to fifth metatarsal heads had been resected, but the resection stumps were covered with pseudo-cartilaginous tissue. This allowed metatarsal shortening offset osteotomy to be performed as a procedure similar to that used in primary surgery, achieving the planned correction. Consequently, both radiographic and clinical improvements were observed. These findings suggest that metatarsal shortening offset osteotomy may be a possible salvage option after primary resection arthroplasty for forefoot deformity in patients with RA.