Forefoot arthroplasty in the arthritic patient.

The forefoot arthroplasty procedure is frequently used in the patient with inflammatory arthritis. There is a multitude of considerations, both local and systemic, in these patients. As with other surgical procedures, it is important that the surgeon evaluate the patient as a whole. Each case should be evaluated individually and modifications made as necessary. There are several modifications of the original technique as described by Hoffman. Ultimately, the surgeon must select which variation works best in his or her hands. This procedure works extremely well when the patients are carefully selected. Patients greater than 50 years of age tend to do the best. They should demonstrate an apropulsive gait at the time of surgery and have an unrelenting metatarsalgia. Complications frequently arise from inadequate resection of bone, which can cause recurrence of deformity. Some regeneration of bone should be expected postoperatively. Patients should be told that they will lose one to two shoe sizes postoperatively. Despite these problems, this procedure has stood the test of time and should provide a high degree of satisfaction for patient and physician alike.