Fusions of the foot and ankle in patients with rheumatoid arthritis

Rheumatoid arthritis commonly affects the foot and ankle. For those patients for whom nonoperative methodologies fail, surgical intervention is required. The most commonly affected area is the forefoot, followed by the hindfoot, midfoot, and ankle. In the forefoot, first metatarsophalangeal fusion, along with resection of the lesser metatarsal heads, is an effective means for correcting deformity and alleviating pain. Some authors recommend isolated talonavicular fusion for hindfoot arthritis. However, our experience indicates that the addition of calcaneocuboid fusion or triple arthrodesis allows a more durable foot with higher fusion rates. Midfoot arthritis with or without deformity can be corrected with fusion and corrective osteotomy as needed. Ankle arthrodesis is often necessary owing to advanced disease or increased stress from previous arthrodeses. In general, we recommend fusion using screw compression techniques with local bone graft. The application of these methods has produced a high fusion rate, minimal complications, and a plantigrade, shoeable foot.