The changes of the rheumatoid forefoot can be graded using the Nijmegen classification. The authors are from The Netherlands.
Patient selection: rheumatoid forefoot
Parameters:
(1) change in the metatarsophalangeal (MTP) joints
(2) radiographic changes using Larsen grades
(3) plantar soft tissue
(4) hallux valgus in degrees
MTP joint
Radiographic Joint Changes
Plantar Soft Tissue
Grade
no change
mild (Larsen 0 or 1)
normal
0
decreased mobility particularly plantar flexion
erosive (Larsen 2 to 5) or intra-articular changes
reduced plantar soft tissue under MT heads and with adequate quality of plantar soft tissue
1
loss of plantar flexion
NA
reduced plantar soft tissue under MT heads and with inadequate quality of plantar soft tissue
2
extension contracture
with or without subluxation or dislocation
3
Hallux Valgus
Subdesignation
> 20 degrees
A
none or <= 20 degrees
B
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Specialty: Surgery, orthopedic, Surgery, general
