Foot abnormalities in rheumatoid arthritis.

By anticipating the deformities that can occur in the rheumatoid foot and by carefully and compulsively looking for them, we can more effectively deal with the pathologic conditions. Although we usually equate conservative care with nonoperative treatment, and shoe corrections are certainly important, early operative intervention may be essential. Procedures we must use early if indicated are as follows: decompression of the posterior tibialis tendon and other medical structures in the tarsal tunnel, excision of intermetatarsal bursae, and talonavicular arthrodesis. Furthermore, relating forefoot to hindfoot deformities is important. A valgus hindfoot should be corrected before laterally dislocated MTP joints. A great deal can now be accomplished in treating the remaining weight-bearing joints of the lower extremity. The possibility of combining some of these procedures while hips or knees are undergoing surgery also exists. For example, it may certainly be reasonable when performing a knee arthroplasty to consider a hindfoot arthrodesis or a forefoot arthroplasty on the opposite side.