{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:02:14Z","timestamp":1785585734423,"version":"3.56.0"},"reference-count":27,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T00:00:00Z","timestamp":1633392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>With the progress of medical treatment for rheumatoid arthritis (RA), several joint-preserving forefoot surgical procedures have been established and performed. In this situation, we have been choosing the combined surgery: modified scarf osteotomy for the great toe and metatarsal shortening offset osteotomy for the lesser toes in RA cases. A retrospective observational study of 53 RA patients (mean follow-up period: 4.6 years) who underwent the surgery was completed. RA foot ankle scores were assessed, using the Japanese Society for Surgery of the Foot (JSSF) standard rating system, and a self-administered foot evaluation questionnaire (SAFE-Q) was also checked to evaluate clinical outcomes. For radiological evaluations, deformity parameters were measured using radiographs of the feet with weight-bearing. JSSF hallux and lesser toes scores and the SAFE-Q score showed significant improvement in all indices. HVA, M1-M2A, M1-M5A, M2-M5A, and sesamoid position were significantly improved after surgery. At the final follow-up, the hallux valgus deformity had recurred in 4 feet (7.5%), and hallux varus deformity had developed in 8 feet (15.1%). No case of recurrent hallux valgus deformity required revision surgery. Recurrence of dorsal dislocation\/subluxation of the lesser toe MTP joint was seen in 6 feet (11.3%) after surgery. A combination of modified scarf osteotomy for the great toe and modified metatarsal shortening offset osteotomy for the lesser toes is one of the novel surgical procedures for rheumatoid forefoot deformity. Preoperative disease activity of RA negatively affected the clinical score of the hallux. The spread of M2-M5A was a risk factor for resubluxation of the lesser toe MTP joint.<\/jats:p>","DOI":"10.3390\/ijerph181910473","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T09:24:04Z","timestamp":1633598644000},"page":"10473","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity"],"prefix":"10.3390","volume":"18","author":[{"given":"Yuki","family":"Etani","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1408-7851","authenticated-orcid":false,"given":"Makoto","family":"Hirao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Ebina","sequence":"additional","affiliation":[{"name":"Department of Musculoskeletal Regenerative Medicine, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9938-6780","authenticated-orcid":false,"given":"Takaaki","family":"Noguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan"},{"name":"Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gensuke","family":"Okamura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai 591-8025, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Miyama","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Osaka Toneyama Medical Center, Toyonaka 560-8552, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai 591-8025, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihide","family":"Nampei","sequence":"additional","affiliation":[{"name":"Nampei Orthopaedics and Rheumatology Clinic, Katsuragi 639-2162, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeyoshi","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan"},{"name":"Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajime","family":"Owaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Osaka Hospital, Osaka 553-0003, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan"},{"name":"Department of Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano 586-8521, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"765","DOI":"10.2106\/JBJS.17.00436","article-title":"Modified Scarf Osteotomy with Medial Capsule Interposition for Hallux Valgus in Rheumatoid Arthritis: A Study of Cases Including Severe First Metatarsophalangeal Joint Destruction","volume":"100","author":"Kushioka","year":"2018","journal-title":"J. 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