Rheumatoid forefoot - Preparation of First MTP
The first step in a rheumatoid correction should be preparation of the first MTP. Access and Procedure is as for standard MTP fusion. If the deformity is particularly great it may be helpful to release the contracted lateral soft tissues through medial aspect of the joint. A vertical lateral capsulotomy may be all that is needed. The rheumatoid bone is often fairly osteopenic. Fixation is best left until all the other toes are dealt with. An appropriately sized dorsal plate and single compressive screw is a reliable combination.