Hindfoot Arthrodesis in Patients with Rheumatoid Arthritis

Hindfoot involvement in patients with rheumatoid arthritis is mainly caused by static and dynamic forces. Isolated synovitis of the upper ankle joint is more rare than alterations following bio-mechanical changes in the region of subtalar and tarsal joints. Early use of insoles and support of the foot by orthotic adaptation or custom-made orthopaedic shoes are able to stop progress by minimising pressure patterns. This is only limited by the patient's acceptance and the absence of an effect in static full weight-bearing pain. Reduced mobility of the patient and pain are clear indications for early arthrodesis of the hindfoot. Loss of pain, full weight-bearing and mobility combined with minimal limitations can be achieved by arthrodesis. Different operative techniques enable us to address all osseous conditions like necrosis, destruction and malalignment by using screws, plates and intramedullary nails. It could be demonstrated that favourable results are achieved and complications minimised below to 5% with regard to infection and pseudoarthrosis. The hindfoot arthrodesis can be recommended without restriction in cases of hindfoot involvement in patients with RA.