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A total of 30 patients (39 feet) with a mean age of 55.6 years (45 to 67) underwent combined first tarsometatarsal fusion and distal realignment, shortening oblique osteotomies of the bases of the second to fourth metatarsals and a fifth-ray osteotomy. <\/jats:p><jats:p> The mean follow-up was 36 months (24 to 68). The mean foot function index scores for pain, disability and activity subscales were 18, 23, and 16 respectively. The mean Japanese Society for Surgery of the Foot score improved significantly from 52.2 (41 to 68) to 89.6 (78 to 97). Post-operatively, 14 patients had forefoot stiffness, but had no disability. Most patients reported highly satisfactory walking ability. Residual deformity and callosities were absent. The mean hallux valgus and intermetatarsal angles decreased from 47.0\u00b0 (20\u00b0 to 67\u00b0) to 9.0\u00b0 (2\u00b0 to 23\u00b0) and from 14.1\u00b0 (9\u00b0 to 20\u00b0) to 4.6\u00b0 (1\u00b0 to 10\u00b0), respectively. Four patients had further surgery including removal of hardware in three and a fifth-ray osteotomy in one. <\/jats:p><jats:p> With good peri-operative medical management of rheumatoid arthritis, surgical repositioning of the metatarsophalangeal joint by metatarsal shortening and consequent relaxing of surrounding soft tissues can be successful. In early to intermediate stages of the disease, it can be performed in preference to joint-sacrificing procedures. <\/jats:p>","DOI":"10.1302\/0301-620x.92b3.23186","type":"journal-article","created":{"date-parts":[[2010,3,1]],"date-time":"2010-03-01T00:12:33Z","timestamp":1267402353000},"page":"380-386","source":"Crossref","is-referenced-by-count":68,"title":["Combination joint-preserving surgery for forefoot deformity in patients with rheumatoid arthritis"],"prefix":"10.1302","volume":"92-B","author":[{"given":"H.","family":"Niki","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Hirano","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Beppu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"Coughlin MJ. 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