Metatarsal Head Resection: Patient Reported Outcomes in Patients Suffering from Rheumatoid Arthritis

Abstract

Category: Midfoot/Forefoot; Lesser Toes Introduction/Purpose: Rheumatoid arthritis (RA) is one of the most common autoimmune inflammatory conditions encountered in a clinical setting. Conservative management of this disease has improved with the use of Disease Modifying Antirheumatic Drugs (DMARDs). When conservative measures fail, surgical treatment is pursued. Metatarsal head resection of the lesser toes with or without first MTP arthrodesis is the operation of choice. There is limited literature on the patient- reported long-term outcomes for this procedure. The aim of this study is to address metatarsal head resection for the treatment of patients suffering from RA and the resultant patient-reported outcomes. Methods: A retrospective analysis of patients that underwent metatarsal head resection at our facility from 2010-2020 was conducted. Patients were selected if they underwent this procedure specifically due to RA. Basic patient demographics, the presence or absence of hammertoes/claw toes, fusion of the great toe, patient medications (DMARDs, steroids), and surgical complications were all recorded with utilization of the electronic medical record (EMR). To evaluate outcomes, we utilized Foot Function Index (FFI) scores as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: 45 patients met the criteria for this study with a total of 24 individuals completing both the FFI and PROMIS score surveys. The average timepoint at which the outcomes were collected was 5.83 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function, pain interference, and depression scores for this population was 40.67, 56.74, and 44.75 respectively. The mean FFI scores were 40.84 for pain, 46.95 for disability, 26.5 for activity limitation. There was a significant decrease in postoperative pain scores when compared to preoperative pain of 4.1 to 2.2 (p=0.01). 2 patients experienced wound complications, 11 patients underwent hammertoe correction and 20 patients had simultaneous 1st MTP arthrodesis. Conclusion: Preliminary results suggest metatarsal head resection in patients with RA may be beneficial in decreasing pain and can lead to long-term patient satisfaction. PROMIS scores were helpful in identifying that patients were functioning roughly at the level of the average person in all aspects. We plan to increase the power of our study for a more thorough investigation as well as conduct a more intensive statistical analysis to gain more insight on patient related factors and their effect on outcomes.