Metatarsal head excision for rheumatoid arthritis. 4-year follow-up of 68 feet with and without hallux fusion.

Thirty-four painful deformed rheumatoid feet treated by excision of all five metatarsal heads were compared with 34 similar feet in which the lesser metatarsal heads were excised and the first metatarsophalangeal joint was arthrodesed. In the latter group, one third had failure of fusion of the hallux, and this produced the worst results. Metatarsalgia and plantar callosities were more common after excision arthroplasty, but shoe fitting and correction of deformity were better in this group. However, the results were more variable in the fusion group, and the complication and reoperation rates were higher. For this reason, excision arthroplasty, rather than fusion of the hallux, is recommended when the lesser metatarsal heads are removed.