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Arthritis und Rheuma 2019; 39(03): 173-182
DOI: 10.1055/a-0863-9086
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Operative Rheumatologie des Vorfußes – ein Trend zu gelenkerhaltenden Eingriffen?

Rheumatoid forefoot deformity – a surgical trend to joint-preserving procedures?
Ingo Arnold∗
1   Rotes Kreuz Krankenhaus Bremen, Rheumazentrum, Klinik für Orthopädie und operative Rheumatologie
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Publication History

Publication Date:
01 July 2019 (online)

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Zusammenfassung

Ein einheitliches, standardisiertes Operationsverfahren existiert aufgrund der Vielfalt der Ausprägungen der rheumatischen Vor- und Rückfußdeformitäten in Zusammenhang mit den unterschiedlichen Funktionsansprüchen und des subjektiven Schmerzempfindens von RA-Patienten nicht [[1]]. Unter einer frühen und aggressiven Therapie der RA zeigen die Patienten mildere Formen von Fußdeformitäten. Diese sind vergleichbar mit den Deformitäten von Patienten, die nicht an einer chronisch entzündlichen Gelenkerkrankung leiden. Neben geringeren Fehlstellungen und weniger ausgeprägten Synovialitiden sind auch polyartikuläre Deformitäten oder begleitende Weichteilentzündungen (Bursitiden oder Tenosynovialitiden) seltener zu beobachten. In solchen Fällen können zunehmend gelenkerhaltende korrigierende Operationsverfahren angewendet werden. Bei dem Vollbild eines erosiven rheumatischen Vorfußes mit Spreizfuß, Hallux valgus, multiplen plantaren Bursitiden, Clavi- sowie Klauenzehen kommt neben der Stabilisierung des 1. Strahles bzw. der medialen Säule (MTP-I-Fusion, modif. Lapidus-Op) nur die Resektionsarthroplastik infrage mit Entfernung der Metatarsalia-Köpfchen. Diese weisen in fortgeschrittenen Fällen oft rheumatische Destruktionen auf und eine korrigierende Osteotomie wäre nur mit einem hohem Risiko persistierender Beschwerden durchzuführen.

Summary

The variety of forms of rheumatic forefoot and hindfoot deformities, the different functional requirements and the individual pain perception of RA patients make a uniform, standardized surgical procedure impossible. Under an early and aggressive therapy, patients show milder forms of foot deformities. Also polyarticular deformities or concomitant soft tissue inflammations (bursitis or tenosynovialitis) are less common. These are in contrast to the deformities of patients who do not suffer from chronic inflammatory joint diseases. The joints also show side effects. The result of this is that, according to our characteristics, joint-preserving corrective surgical procedures are used. In a full-size picture of an erosive rheumatic forefoot with multiple bursitis, clavi- and claw toes (i. e. the dorsal subluxation of the basal phalanx), only the resection arthroplasty is useful. In those cases joint preserving techniques of the metatarsal heads are at high risks for recurrence of the deformities.

Schlüsselwörter

Rheumatischer Spreizfuß - MTP-Arthrodese - plantare Platte - Zehendeformität

Keywords

Rheumatoid forefoot deformity - MTP arthrodesis - plantar plate - toe deformity - rheumatoid surgical foot and ankle
 

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