Arthroplasty of the forefoot in rheumatoid arthritis: long-term results after Clayton procedure.

The present study aims to evaluate long-term results after Clayton resection arthroplasty in patients with symptomatic arthritis of the forefeet. From 1970 to 1995, 109 patients with a total of 184 rheumatoid forefeet underwent Clayton's procedure at an average age of 60 years. Forty-seven of them returned with 82 operated feet for follow-up by means of patient history, physical examination and radiograph an average of 12.8 years later. Overall outcome was judged as successful in 60 of the 82 cases with complete pain relief, remarkably improved gait capacity and use of normal shoes. Sixteen of the feet were definitely improved, but slight to moderate pain, inadequate balance and contact with the ground, limited walking distance and use of large shoes were signs of decreased operation success. The remaining 5 feet showed recurrent splay-foot deformity with intolerable pain, functional disability and restricted gait capacity even though specially made surgical shoes were used. The Clayton procedure appears to be a suitable method for surgical correction of symptomatic rheumatoid forefeet.