Arthroscopy of the first metatarsophalangeal joint.
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We carried out 12 arthroscopies of the first metatarsophalangeal (MTP) joint in 11 patients over a five-year period. Their mean age was 30 years (15 to 58) and the mean duration of symptoms before surgery was eight months (1 to 24). Six patients had an injury to the joint; all had swelling and tenderness with a reduced range of movement. In six patients, radiographs revealed no abnormality. Under general anaesthesia with a tourniquet the hallux is suspended by a large Chinese finger trap to distract the joint. Using a 1.9 mm 30 degree oblique arthroscope the MTP joint is inspected through dorsomedial and dorsolateral portals with a medial portal if necessary. All patients were found to have intra-articular pathology, which was treated using small instruments. The mean follow-up was 19.3 months (6 to 62) and all patients had no or minimal pain, decreased swelling and an increased range of movement of the affected joint. (+info)
Prognostic value of early features in rheumatoid disease.
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Extensive data on 102 patients who presented with rheumatoid disease within a year of onset were gathered by a prospective study to assess the prognostic value of early features. Outcome was evaluated at a mean 4-5 years from onset on the basis of functional grade, extent of joint disease, early morning stiffness, and grip strength. Twenty-six patients improved, 14 pursued a mild steady course, and 62 had a persistently severe or deteriorating condition. The features recorded at the first visit were correlated with outcome. Those indicating a poor prognosis were: older age at onset, being underweight, poor grip strength, many affected joints, involvement of wrist or metatarsophalangeal joints, poor functional status, fulfilment of many of the American Rheumatism Association criteria for rheumatoid disease, raised erythrocyte sedimentation rate, seropositivity on sheep cell agglutination or latex tests, low haemoglobin level, raised blood urea level, and early erosions on x-ray films. (+info)
Pathogenesis of Salmonella-associated arithritis in the rat.
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The distribution of joint lesions in rats with Salmonella-associated arthritis (SSA), as determined in a detailed survey, resembles to a great extent the pattern of small joint involvement in human rheumatoid arthritis. Such lesions, though regularly induced in the rat by the intravenous injection of live S.enteritidis, could not be evoked by the heat-killed organisms injected by various routes with and without extrinsic adjuvants. Efforts to transfer SAA from sensitized donors to either normal or primed recipients, employing lymphoid ce-ls from several sources, also failed repeatedly. Two observations, however, virtually exclude the possibility that joint damage in SAA can be the direct result of sustained intra-articular sepsis. First, the inoculation of as many as 10-3 viable inflammation. Second, the incidence of SAA was significantly lower in weanling rats in the adult controls although the growth and distribution of intravenously injected S. enteritidis was virtually identical in the two groups. Together these observations indicate that the joint damage occurring in SAA is determined by the host and not by the infecting organism. From this, it seems fair to conclude that the destructive arthritis characteristic of this syndrome is immunologically mediated. (+info)
Rheumatoid plantar synovial cysts.
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A patient is described with rheumatoid arthritis and a painful synovial cyst, which originated from a metatarsophalangeal joint and presented as a swelling on the plantar surface of the foot. The cyst was successfully excised. (+info)
Metatarsal osteotomy for metatarsalgia.
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An oblique osteotomy in the distal half of the metatarsal shaft is described for the treatment of metatarsalgia due to prolapse of one or more of the middle three metatarsal heads. Thirty-eight patients who have had this operation have been followed up for a period of from two to five years. The operation is simple, recovery is rapid and symptoms have been well relieved. (+info)
Dorsal dislocation of the first metatarso-phalangeal joint. Report of four cases.
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The anatomy of the first metatarso-phalangeal joint and of dorsal dislocation of the phalanx are described. As similar lesions in the hand, closed reduction is impossible because of interposition of the volar plate. Open reduction is essential and should be performed as soon as possible after the injury. (+info)
The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis.
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We performed a retrospective study in 188 patients (254 feet) with rheumatoid arthritis and compared the late results of Keller's procedure with those of Hueter-Mayo's technique after 7.9 years. More than 60% of the Keller group and 30% of the Hueter-Mayo group were suffering from persistent metatarsalgia due to increased forefoot pressure as well as experiencing pain around the great toe. Plantar callosities, recurrent hallux valgus deformity, lack of plantar flexion and weakened push-off were more frequent after Keller's procedure. (+info)
The foot in chronic rheumatoid arthritis.
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The feet of 200 consecutive admissions with classical or definite rheumatoid arthritis were studied. 104 were found to have pain or deformity. Clinical involvement of the joints was seen more often than radiological joint damage in the ankle, but the reverse was the case in the midtarsal joints. The metatarsophalangeal joints were involved most frequently both clinically and radiologically. Sixty per cent of the patients required modified shoes but only a third of these had received them. The need for more shoes is clear, and although this is a highly selected group of patients they were all under specialist care. The increased expenditure on special footwear would benefit the patient, firstly by improving ambulation, and secondly perhaps by reducing the number of operations necessary. Hallux valgus was very common and occurred with similar frequency to disease in the other metatarsophalangeal joints. Although not exclusive to rheumatoid arthritis, hallux valgus must have been caused for the most part by the rheumatoid arthritis and if so, then it is suggested that the provision of suitable shoes for patients may be less costly than subsequent surgical treatment. (+info)