Patient selection: rheumatoid arthritis
When to consider surgery - both of the following:
(1) failure of non-surgical interventions
(2) significant pain, deformity and/or disability
Non-surgical interventions:
(1) orthotics (cushioning, arch support, heel wedge, special shoes)
(2) physiotherapy
(3) steroid or local anesthetic injections into painful joints under imaging guidance
Problems causing pain, deformity or disability:
(1) painful bunion
(2) painful stiff first metatarsophalangeal joint
(3) destruction of the plantar plate
(4) frank dislocations of metatarsophalangeal joints
(5) clawed or mallet toes
(6) significant ulcerations or calluses
(7) worsening deformity causing disability or interfering with shoe wear
