The Association Between a Hindfoot Deformity Assessed by Weightbearing CT and the Full Leg Alignment

Category: Hindfoot Introduction/Purpose: The exact relationship between different types of hindfoot deformities and the full leg alignment is currently unclear. Therefore, our aim is to assess hindfoot alignment on a weight-bearing CT (WBCT) and its association with the full leg radiographic alignment. Methods: A retrospective analysis was performed on a study population of 109 patients (mean age of 53 years ± 14.49) with a varus or valgus hindfoot deformity and the presence or absence of ankle osteoarthritis (OA) based on the Takakura classification. The mechanical hindfoot - (mHA) and subtalar vertical angle (SVA) were determined on WBCT, while the mechanical tiba – (mTA) and mechanical tibiofemoral angle (mTFA) were measured on full leg radiographs. Results: In patients with ankle OA, a hindfoot valgus deformity was associated with a significantly higher mean varus alignment of the knee (mTFA = -1.8°±2.1; mTAx= -4.3°±1.9) compared to a valgus alignment of the knee (mTFA = 0.3°±2.6; mTAx= -1.4°±2.2; P <0.001) in patients with a varus hindfoot (Fig1A, B). The opposite relation was found in patients without ankle OA (P <0.001). The SVA was significantly more orientated in valgus (mean=106.9°±8.0) for patients with a hindfoot valgus compared to a higher varus orientation (mean=89.3°±13.9) in patients with a hindfoot varus deformity (P <0.001). The same pattern was found in patients without ankle OA, but not significant (P >0.05). Conclusion: A valgus hindfoot deformity demonstrated a higher varus alignment of the knee when compared to patients with a hindfoot varus deformity, if ankle OA was present. The subtalar joint did not attain an overall compensatory correction towards the hindfoot deformity as opposed to a compensatory orientation of the tibia alignment. In clinical practice, these findings could improve the current understanding of both joint preserving as well as joint replacing procedures of the hindfoot and the knee.

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Three-Dimensional Displacement after a Medializing Calcaneal Osteotomy in Relation to the Hindfoot Alignment and Osteotomy Angle

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00060 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0006

Author(s):

Matthias Peiffer ◽

C. Belvedere ◽

S. Clockaerts ◽

T. Leenders ◽

Alexej Barg ◽

...

Keyword(s):

Weight Bearing ◽

Three Dimensional ◽

Valgus Deformity ◽

Flat Foot ◽

Hindfoot Alignment ◽

Calcaneal Osteotomy ◽

Bony Landmarks ◽

Operative Planning ◽

Osteotomy Plane ◽

Computer Based

Category: Hindfoot Introduction/Purpose: An adult-acquired flatfoot deformity is a three-dimensional (3D) condition characterized by a loss of the medial longitudinal arch, valgus alignment of the hindfoot, and abduction of the midfoot. When conservative measures are not sufficient, a medializing calcaneal osteotomy (MCO) is frequently performed to correct the deformity, but there is lack of data on the associated three-dimensional variables defining the final correction. A possible reason for this shortcoming could be the current image-based analyses, mainly performed on bi-dimensional radiographs. These are hampered by errors in 3D rotations and superimposition of bony structures. The aim of this study was therefore to assess the correlation between the preoperative hindfoot valgus deformity and calcaneal osteotomy angle and the postoperative calcaneal displacement by use of weightbearing CT (WBCT). Methods: Weight-bearing CT scans obtained pre- and post-operatively were analyzed for sixteen patients with a mean age of 49.4 years (range: 18-66 years). Indication for surgery was adult-acquired flat foot deformity stage II. Based on the WBCT images, pre- and post-operative 3D bone morphological models of the tibia, talus, calcaneus, and the second metatarsal were created, on which anatomical bony landmarks were computationally identified to define a Foot Anatomical reference Frame (FAF). This FAF was used to measure valgus deformity pre- and post-operatively, inclination of the osteotomy plane, and displacement of the calcaneus (Fig. 1). Linear regression was conducted to assess the relationship between these measurements. Results: On average, the hindfoot valgus changed from 13.1° (±4.6) preoperatively to 5.7° (±4.3) postoperatively. A mean inferior displacement of 3.2 mm (±1.3) was observed along the osteotomy with a mean inclination angle of 54.6° (±5.6), 80.5° (±10.7), - 13.7° (±15.7) in the axial, sagittal and coronal planes, respectively. A statistically significant positive relationship (P < .05, R2 = 0.6) was found between the preoperative valgus, the axial osteotomy inclination, and the inferior displacement. Conclusion: This study shows that the degree of preoperative valgus of the hindfoot and the axial osteotomy angle are predictive factors for the amount of postoperative plantar displacement of the calcaneus. These findings contrast the general recommendation of performing a 90° calcaneal osteotomy angle, i.e. perpendicular to the lateral calcaneal wall in every patient. The obtained factors should be taken into account when performing a MCO and could be integrated in a computer-based pre- operative planning.

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3D biometrics for hindfoot alignment using Weight Bearing CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00323 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Francois Lintz ◽

Shu Zhang ◽

Alessio Bernasconi ◽

Jianzhong Zhang

Keyword(s):

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Continuous Series ◽

Hindfoot Alignment ◽

Group 3 ◽

Group 2 ◽

Weightbearing Ct ◽

Group 1

Category: Hindfoot Introduction/Purpose: Hindfoot alignment is an important reference for foot and ankle surgery, and the Foot Ankle Offset (FAO) using semi-automatic software has been reported as a valuable hindfoot alignment measurement in weightbearing CT(WBCT). The objective was to assess the clinical relevance and reproducibility of the FAO value for hindfoot alignment and compare it with previous findings. Methods: A prospective study was conducted, with ethics committee approval. Patients were included, clinically examined and divided into 3 groups: normal alignment (Group 1), valgus (Group 2), varus (Group 3). A continuous series of 140 feet (71 patients) were referred from September to December 2017 (65 normal, 41 valgus, and 34 varus). All patients had a bilateral weight bearing CT, and the FAO values were recorded. The long axial view angle(HAct)was measured on Digitally Reconstructed Radiographs (DRR) as comparison. All values were measured and compared by two different investigators. The reproducibility of FAO and HAct were calculated using intraclass correlation coefficients(ICCs) and regression analysis was conducted to study the correlation between the two methods. Results: In Group 1, the mean value for FAO/HAct was 1.69%±2.58%/4.13±2.67, in Group 2, the FAO/HAct was 7.46%±3.18%/9.00±3.43; in Group 3 the values were -6.11%±4.55%/-7.49±6.06. The intra- and interobserver reliability were 0.991/0.992 and 0.976/0.976. There was a good linear correlation between HAct and FAO (R2=0.778, and the regression slope was 1.083. Conclusion: The use of weightbearing CT can help characterize hindfoot alignment objectively using WBCT. The present study is the first prospective comparative assessment of this technology and shows that FAO has good repeatability, and it correlates well with clinical examination,, X ray findings and previous literature. The FAO is a clinically relevant and reproducible method for measuring hindfoot alignment.

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The Rationale of Osteotomy around the Knee

The Journal of Knee Surgery ◽

10.1055/s-0037-1603755 ◽

2017 ◽

Vol 30 (05) ◽

pp. 386-392 ◽

Cited By ~ 3

Author(s):

Philipp Lobenhoffer

Keyword(s):

Sagittal Plane ◽

Weight Bearing ◽

Cartilage Damage ◽

Frontal Plane ◽

Varus Deformity ◽

Valgus Deformity ◽

Wedge Osteotomy ◽

Early Weight Bearing ◽

Plate Fixator ◽

Closed Wedge

AbstractFrontal plane varus or valgus deformity causes overload in the ipsilateral compartment and may induce and accelerate cartilage damage. Osteotomy around the knee should be considered in symptomatic constitutional and posttraumatic metaphyseal deformities of more than 3-degree deviation. Age, grade of osteoarthritis, obesity, and nicotine consumption are no exclusion criteria for osteotomy. For correction of varus deformity, biplanar open wedge osteotomy of the tibia with fixation by a plate fixator has proven to be a safe and stable construct allowing for early weight-bearing. Valgus deformities of the tibia can be treated by biplanar closed wedge osteotomy of the proximal tibia. For femur deformities closed wedge biplanar osteotomy and fixation with a specific plate fixator is an attractive solution reducing implant-related morbidity. Osteotomy around the knee may also be used to protect cartilage reconstruction and meniscus transplantation. Corrections in the sagittal plane may improve the anteroposterior stability of the knee significantly and can be combined with frontal plane corrections.

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Changes in the Ankle Joint and Hindfoot Alignment Following Varus Deformity Correction of the Knee with Total Knee Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000051 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Bi O Jeong ◽

Jong Hun Baek ◽

Wookjae Song

Keyword(s):

Knee Joint ◽

Ankle Joint ◽

Mechanical Axis ◽

Deformity Correction ◽

Varus Deformity ◽

Valgus Deformity ◽

Hindfoot Alignment ◽

Total Knee ◽

The Mean ◽

Surface Angle

Category: Ankle, Hindfoot Introduction/Purpose: Compensatory changes occur in the ankle joint and the subtalar joint of the hindfoot to maintain neutral alignment in coronal plane when varus or valgus deformity is present in the knee joint. The purpose of this study is (1) to analyze how the ankle and hindfoot joint compensate the changes in mechanical axis that occur with varus deformity of the knee, (2) to analyze the changes in ankle and hindfoot joint alignment when mechanical axis alignment is corrected by correction of varus deformity of the knee with total knee arthroplasty (TKA), and (3) to radiographically evaluate the degree of changes in ankle and hindfoot joint alignment according to the degree of varus deformity correction. Methods: 375 knees that underwent TKA with varus deformity were prospectively studied. The degree of varus deformity of the knee joint was measured in standing long leg anteroposterior views taken before and 6 months after TKA. The angle between the ground surface and the superior dome of the talus, and the talar tilt were measured in standing ankle joint anteroposterior views taken before and 6 months after TKA. Preoperative tibial anterior surface angle and tibial lateral surface angle were measured. Hindfoot alignment was evaluated in hindfoot alignment views taken before and 6 months after operation by measuring the heel ratio, the heel angle, and the heel distance. These measurements were used to analyze the change in ankle joint and hindfoot alignment between before and 6 months after varus deformity correction. The relationship between the degree of varus knee correction and the change in ankle joint and hindfoot alignment was also analyzed. Results: The mean mechanical angle of the knee changed from varus 10.6±5.1° before operation to varus 0.1±3.2° after operation, which was statistically significant (P<0.001). The mean correction angle was 10.6±4.6°. Before operation, the mean tibial anterior surface angle was 89.9±3.1° and the mean tibial lateral surface angle was 81.5±2.9°. Talar tilt changed significantly from 0.3±2.0° to 0.0±1.6°, implying a varus change of the ankle joint (P=0.002). All of the evaluated hindfoot alignment parameters demonstrated a significant varus change (P<0.001), as the heel ratio changed from 0.2±0.2 preoperatively to 0.3±0.2 postoperatively (P<0.001), the heel angle changed from 11.4±7.0° preoperatively to 5.0±7.4°postoperatively (P<0.001), and the heel distance changed from 10.5±6.6 mm preoperatively to 6.4±6.4 mm postoperatively (P<0.000). Conclusion: Varus knee deformity tended to be associated with valgus deformity of the ankle joint and hindfoot alignment. Alignment in the ankle joint and the hindfoot both changed to a varus trend after correction of varus deformity of the knee. Such changes in ankle joint and hindfoot alignment are considered to be due to the compensatory changes following alterations in lower limb alignment. Therefore, it is necessary to perform a meticulous examination of the ankle joint as well as the knee joint and consider subsequent alteration of ankle joint and hindfoot alignment before surgical correction of knee joint alignment.

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Surgical correction of hallux valgus complicated with adult-type pes plano-valgus

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684320 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668432

Author(s):

Jun Young Choi ◽

Hyeong Hwa Yoon ◽

Yu Min Suh ◽

Jin Soo Suh

Keyword(s):

Hallux Valgus ◽

Varus Deformity ◽

Postoperative Recurrence ◽

Valgus Deformity ◽

Adult Type ◽

Pes Planus ◽

Hindfoot Alignment ◽

Hallux Valgus Deformity ◽

Pes Plano Valgus ◽

Severe Hallux Valgus

Purpose: To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Methods: Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. Results: The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Conclusion: Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

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Changes of hindfoot alignment after high or low tibial osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00191 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0019

Author(s):

Jun Young Choi ◽

Jin Soo Suh ◽

Dong Joo Lee

Keyword(s):

Ankle Joint ◽

Normal Values ◽

Varus Deformity ◽

Tibial Osteotomy ◽

Moment Arm ◽

Varus Alignment ◽

Hindfoot Alignment ◽

Radiographic Findings ◽

Radiographic Parameters ◽

Significant Change

Category: Hindfoot Introduction/Purpose: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively (P=0.03 and 0.001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change (P=0.001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased (P=0.001 for each), which represented a hindfoot alignment change to the valgus position. Conclusion: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO.

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Reliability of Hindfoot Alignment Using Weightbearing CT Semi Automatic Software

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000058 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Francois Lintz ◽

Matthew Welck ◽

Alessio Bernasconi ◽

James Thornton ◽

Nicholas Cullen ◽

...

Keyword(s):

Gaussian Distribution ◽

Normal Population ◽

Interobserver Reliability ◽

Weight Bearing ◽

Mean Value ◽

Measurement Tool ◽

Hindfoot Alignment ◽

Clinically Normal ◽

Automatic Software ◽

Weightbearing Ct

Category: Ankle, Hindfoot, Imaging Introduction/Purpose: Hindfoot Alignment (HA) on 2D radiographs presents anatomical and operator-related bias. In this study, weightbearing CT (WBCT) was used to measure HA using a semi-automatic software which gives HA as a value of Foot Ankle Offset (FAO) after selecting four landmarks (weight bearing points of first and fifth Metatarsals, Calcaneus and center of the ankle joint). We assessed the intra and interobserver reproducibility and the distribution of FAO values in a series of datasets from clinically normal, varus and valgus cases. We hypothesized that reproducibility would be excellent. Furthermore, FAO in normals should have a Gaussian distribution and be significantly different to the varus and valgus groups. Methods: In this level 3, retrospective comparative study, WBCT (PedCAT ®, CurveBeam LLC, Warrington, PA, USA) datasets were obtained from an existing database. The 135 feet were assessed by a senior foot and ankle surgeon as normal, varus or valgus (57, 38 and 40 respectively). Two surgeon investigators (one senior and one trainee) independently analyzed each case using a semi-automatic HA measurement tool (TALAS ™, CurveBeam LLC, Warrington, PA, USA). A third, independent investigator conducted the statistical analysis using Stata® Software. Results: The overall intraoberver and interobserver reliability were 0.99 ± 0.002 and 0.97 ± 0.02 respectively. In normal cases, mean value for FAO was 2.38% ± 2.96, whereas in varus and valgus cases mean was -11.67% ± 6.90 and 11.47% ± 5.79, respectively (p<0.001). The normal population had a Gaussian distribution with a Kolmogorov-Smirnov test > 0.8 Conclusion: This study reports excellent reliability and discriminative power of a semi-automatic 3D measurement tool for Hindfoot Alignment in WBCT.

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Deformity and Clinical Outcomes Following Surgical Correction of Charcot Foot

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000072 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Michael Pinzur ◽

Adam Schiff

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Weight Bearing ◽

Varus Deformity ◽

Valgus Deformity ◽

Surgical Correction ◽

Charcot Foot ◽

Patient Reported ◽

Favorable Clinical Outcome ◽

One Year

Category: Diabetes Introduction/Purpose: There is growing acceptance that the historic accommodative treatment of the acquired deformity associated with Charcot Foot arthropathy leads to very poor patient reported outcomes. Surgical correction of the acquired deformity is now advised with the goals of improving ambulation and quality of life. Methods: Over a twelve-year period, 214 consecutive patients (9 bilateral) underwent surgi-cal reconstruction of the acquired deformity associated with symptomatic midtarsal dia-betes- associated Charcot Foot arthropathy. The patterns of midtarsal deformity were ar-bitrarily stratified into three clinical groups based on observed weight bearing pattern, radiographic relationship of the forefoot to the hindfoot and integrity of the talo-calcaneal joint. All patients were followed for a minimum of one year. All had weight bearing radiographs before surgery and at a minimum of one year following surgery. A VALGUS deformity pattern was present in 138, VARUS in 48 and DISLOCATION of the talo-calcaneal joint in 37. Surgery included tendon-Achilles lengthening and an attempt at bony correction of the non-plantigrade clinical deformity. Immobilization in all cases was accomplished with a three level static circular external fixator. Clinical outcomes were based on suc-cessfu1 resolution of infection and the ability to resume independent walking with com-mercially-available therapeutic footwear. Results: Seven patients died within a year of surgery. Overall, 173 of 216 feet (80.1%) achieved a favorable clinical outcome rating. The VALGUS deformity pattern was the most common, with 120 of 138 patients (89.6%) achieving a favorable clinical outcome rating. There were two transtibial and one transmetatarsal amputations in this group. Twenty-seven of the 48 patients (58.7%) with a VARUS deformity pattern achieved a favorable clinical outcome rating, with seven undergoing transtibial, one Syme’s and one transmetatarsal amputation. There were thirty- seven patients with a valgus deformity pattern characterized by loss of integrity, i.e. DISLOCATION, of the talo-calcaneal joint. Correction of deformity and a favorable clinical outcome rating was achieved in twenty-six (72.2%), with one knee disarticulation and two transtibial amputations. Conclusion: Overall, 176 of 223 (77.6%) patients, many with severe structural deformity and osteomyelitis, achieved a favorable clinical outcome. Patients with a VARUS deformity pattern, or loss of integrity of the talocalcaneal joint, were less likely to achieve a favora-ble clinical outcome rating. This retrospective case series suggests a reasonably good probability of improving clinical outcomes in this complex patient population. This de-formity stratification should be helpful going forward when counseling patients with non-plantigrade diabetes- associated Charcot Foot deformity on the risk-benefit ratio associat-ed with surgical correction of their acquired deformity.

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Changes in Hindfoot Alignment After High or Low Tibial Osteotomy

Foot & Ankle International ◽

10.1177/1071100718773767 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1097-1105 ◽

Cited By ~ 4

Author(s):

Jun Young Choi ◽

Si Jung Song ◽

Sung Jung Kim ◽

Sang Hee Kim ◽

Ji Soo Park ◽

...

Keyword(s):

Ankle Joint ◽

Normal Values ◽

Varus Deformity ◽

Tibial Osteotomy ◽

Moment Arm ◽

Varus Alignment ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Radiographic Findings ◽

Radiographic Parameters

Background: We aimed to determine the change in hindfoot alignment after high (HTO) or low tibial osteotomy (LTO), which is commonly performed to prevent the progression of arthritis of the knee or ankle. Methods: We retrospectively reviewed the radiographic findings of patients who underwent HTO or LTO for arthritis with varus deformity of the knee or ankle joint. The hindfoot alignment view angle (HAVA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA) were measured using the hindfoot alignment radiographs. All radiographic parameters were measured at 3, 6, and 12 months postoperatively to assess serial changes. Results: In the HTO group, the HAVA and HMA were significantly increased at 12 months postoperatively compared to preoperatively ( P = .03 and .001, respectively). Similarly, the HAR increased from 0.23 preoperatively to 0.44 at 12 months postoperatively, which was a statistically significant change ( P = .001). In the LTO group, the 12-month postoperative HAVA, HAR, and HMA were significantly decreased ( P = .001 for each), which represented a hindfoot alignment change to the valgus position. Conclusions: After HTO, preoperative hindfoot valgus deviation was significantly decreased at 12 months and approached normal values, while the preoperative mild hindfoot varus alignment was changed to valgus deviation after LTO. Level of Evidence: Level III, comparative series.

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Combination of Modified Scarf Osteotomy and Metatarsal Shortening Offset Osteotomy for Rheumatoid Forefoot Deformity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910473 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10473

Author(s):

Yuki Etani ◽

Makoto Hirao ◽

Kosuke Ebina ◽

Takaaki Noguchi ◽

Gensuke Okamura ◽

...

Keyword(s):

Hallux Valgus ◽

Surgical Procedures ◽

Weight Bearing ◽

Varus Deformity ◽

Valgus Deformity ◽

Great Toe ◽

Forefoot Deformity ◽

Scarf Osteotomy ◽

Hallux Valgus Deformity

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.

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