Midterm severe forefoot deformity treatment outcomes in elderly patients

About authors

Pirogov Russian National Research Medical University, Moscow, Russia

Correspondence should be addressed: Alexey S. Abilemets
Ostrovityanov, 1, Moscow, 117997, Russia; аur.liam@stemelib

About paper

Author contribution: Egiazaryan KA — statement of the problem of managing the patients, manuscript editing; Ratyev AP — study concept, literature review, interpretation of the treatment outcomes; Miroshnikova EA — developing the study concept, theoretical justification of treatment, surgical treatment and monitoring of patients, data acquisition and analysis; Zhavoronkov EA — treatment of patients, postoperative management, assessment of medium-term treatment outcomes; Abilemets AS — surgical treatment, monitoring of patients, data acquisition and analysis, assessment of midterm treatment outcomes, manuscript editing.

Compliance with ethical standards: the study was approved by the Ethics Committee of Pirogov Russian National Research Medical University (protocol No. 181 of 28 January 2018). All patients submitted the informed consent to study participation.

Received: 2023-02-02 Accepted: 2023-02-20 Published online: 2023-02-28

Severe complex deformities of the forefoot in elderly patients with no rheumatoid arthritis result in the pronounced decrease in quality of life, chronic pain, reduced mobility, failure to get shoes for everyday use, exacerbation of the concomitant somatic diseases. The use of conventional  joint preservation techniques in such patients often leads to the deformity relapse, persistent pain, and the need for revision surgery that is often impossible due to worsening of the patients' general somatic status and local functional status. The study was aimed to improve surgical outcomes in elderly patients with no rheumatoid arthritis who had severe forefoot deformities. The prospective cohort study that involved allocation to the retrospective group for comparison of surgical outcomes in 65 patients was carried out in 2016–2019. The results obtained before and after surgery were assessed using the FFI, AOFAS Hallux, and AOFAS Lesser Toes scores. The Maryland scores were used to assess the outcomes during the postoperative period. The study revealed significant differences in treatment outcomes based on the AOFAS Hallux (p = 0.0001), AOFAS Lesser Toes (p = 0.0001), FFI (p = 0.0001), and Maryland (p = 0.0001) scores. In view of the elderly patients' specific nature, the radical surgical techniques that do not ensure joint preservation may be considered as effective and predictable methods of correction aimed at reducing the rate of revision surgeries. These techniques represent a one-step method to improve the quality of life of elderly patients.

Keywords: flat-valgus foot, metatarsalgia, forefoot