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IT HAS BEEN REPORTED in earlier literature that 100 percent of patients with rheumatoid arthritis will develop a synovitis-mediated foot deformity within 10 years of disease onset. 1 The classic picture of the rheumatoid foot is a deranged forefoot deformity involving all metatarsophalangeal joints. This foot type would often require reconstructive surgery to provide the pain relief and functional improvement that orthopedic shoes cannot afford. However, safer and more effective antirheumatic drugs have been developed and incorporated into the management of these patients. Greater control of extremity synovitis has resulted in significantly less articular destruction and deformity in this patient population. In fact, foot and ankle specialists are more likely to see common, mechanically induced forefoot deformities in patients who also have rheumatoid arthritis, as opposed to the other way around. The new breed of rheumatoid patients present a unique chal- lenge. They certainly do not have the deformity or underlying disease severity to indicate the end-stage ablative procedures commonly used in the past, but there is still concern over deformity recurrence and long-term outcomes, given the presence of a chronic disease. It is the opinion of the author that a hybrid approach that aggressively addresses underlying pathomechanics while striving to preserve motion needs to be taken. Dr. Whitaker is board certified by the American Board of Foot and Ankle Surgery and is a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor of Podiatric Surgery at Kent State University College of Podiatric Medicine, in Independence, Ohio. ■ Reference: 1. Haro AA, Moore LF, Schorn K, DiDomenico LA; The Surgical Reconstruction of the Rheumatoid Forefoot, Clin Podiatr Med Surg 27 (2010) 243–259 . ++++++++++++++++ +++ + +++ + ++++++++++++++++ ❮ PODIATRY Where Are We Today? By Jeffrey M. Whitaker, DPM, FACFAS The Rheumatoid Foot: Innovative Solutions for Your Health Care Business Akron n Cleveland n Lorain County n www.brouse.com Collective Experience. Collaborative Culture. Creative Solutions. With a keen understanding of the operations, market trends and economics of the health care industry, Brouse is poised to proactively counsel and advise a wide array of health care clients, including: ■ n Multi - & Single - Physician Groups ■ n Hospitals & Health Systems ■ n Ancillary Service Providers ■ n Long Term Care Facilities ■ n Home Health Care Providers ■ n Medical Device Companies ■ n Mental Health Service Providers ■ n Durable Medical Equipment & Supply Companies For more information, please contact: Daniel Glessner, Esq., Practice Chair 330.535.5711 x316 dglessner@brouse.com Christopher Huryn, Esq., Partner 330.535.5711 x389 churyn@brouse.com David Schweighoefer, Esq., Partner 216.830.6830 x277 dschweighoefer@brouse.com J. Ryan Williams, Esq., Partner 216.830.6830 x592 rwilliams@brouse.com