Rheumatoid Forefoot

Rheumatoid arthirtis is a chronic systemic autoimmune disease with a genetic predisposition. Deformities of the forefoot in patients with rheumatoid arthritis are characterised by the destruction of both the osseous and the soft tissue structures

A typical patient with rheumatoid forefoot disease may have :

  • Components of hallux valgus (bunion deformity),
  • Metatarsalgia (pain over the ball of foot with loss of fat pad)
  • Hammertoe deformities.
  • Painful thick callous areas under the ball of the foot or on the tops of the toe

Surgical Procedures:

Major Forefoot Reconstruction:

This procedure removes all the lesser metatarsal heads and fuses the first MTP joint.
Resulting in pain relief, deformity correction, and a shoeable foot

Rheumatoid Forefoot Surgery
Post Operative Instructions


  • You will have a dressing on your foot for 2 weeks following surgery
  • A post op shoe will be worn for 6 weeks post op
  • Any exposed wires are covered by CLEAR tape
  • At 6 weeks, you will wean off the shoe and begin walking in a regular shoe


  • The surgical incision has been closed with sutures
  • Do not get the dressing or wound wet for the first two weeks.
  • When showering place a bag over the dressing and secure with tape to your leg to avoid the cast and wound getting wet
  • Stitches will be removed at your 2 week appointment
  • After the stitches are removed, you may begin to shower after 2-3 days
  • Do not immerse the foot in water (bath, hot tub, pool) for 6 weeks
  • Do not apply any lotions or creams on the wound for 6 weeks

Weight Bearing:

  • You will be weight bearing as tolerated for the first 6 weeks while in a post op shoe.
  • You will use a mobility device to offload your foot (crutches, walker, stirrup cast)


  • Pain medication should be used regularly for the first 24-48 hours, when required for the first 1 to 2 weeks, followed by Regular Tylenol


  • For right foot surgery you are not permitted to drive until you have completely weaned off the past op shoe
  • For left foot surgery, please contact your insurance company to see if you are permitted to drive
  • Driving is not permitted while on narcotics


  • Two weeks off work is recommended for initial recovery
  • If you are able to get to work safely, and will be seated for the majority of the day, you may return to work four to six weeks after surgery. This is assuming you are not taking narcotic pain mediation.
  • From 2-6 weeks sedentary duties is recommended
  • By 6 weeks you can gradually return to full duties
  • If your job is physically demanding, return to full duties is usually possible around 8-12 weeks post operatively

Follow Up:

  • You will have your first appointment 2 weeks after surgery in the Fracture Clinic
  • Your next appointments will be at 6 weeks, 3 months then 6 months post operatively
  • You will have x-rays taken at these appointments


  • It is normal to experience mild to moderate pain, numbness, or tingling for the first 2 weeks following surgery
  • Please come to the emergency department if you are suffering from severe pain
  • You will get back to most of your activities by 6-12 months
  • Swelling often remains for 6-12 months
  • Residual stiffness is a normal consequence of ankle fracture