Severe deformities of the forefoot in 2025
Seance of wednesday 22 october 2025 (L'Académie reçoit l'Association Française de la Chirurgie du Pied (AFCP))
DOI number : 10.26299/h5hx-xc09/emem.2025.43.03
Abstract
A severe deformity of the forefoot is characterized by concomitant involvement of the lateral rays (2, 3, 4, 5) and the 1st ray. These attacks can be of 3 origins:
- Advanced static deformity: this is the evolution of non-operated hallux valgus. - -
- Inflammatory forefoot, especially rheumatoid arthritis
- Iatrogenic deformations
Fortunately, these deformities are decreasing thanks to several parameters: patients come to the operation earlier because foot surgery has a better reputation: less invasive surgeries, therefore less painful and better controlled thanks to the raising of the level of surgeons, and to specialization. This goes hand in hand with the decrease in iatrogenics. Progress in anti-inflammatory therapies drastically reduces rheumatoid damage to the forefoot.
The therapeutic strategy for these severe deformities revolves around the notion of restoring function, the alignment of the toes, and whether or not the joints are preserved. And of course the restoration of indolence. The notion of global metatarsal shortening established by LS Barouk 25 years ago (MS point) is still valid, but the means to achieve this have evolved since percutaneous surgery of the lateral rays makes it possible to extend the indications. However, for large shortening, Weil's osteotomy is still indicated.
- Advanced static deformity: this is the evolution of non-operated hallux valgus. - -
- Inflammatory forefoot, especially rheumatoid arthritis
- Iatrogenic deformations
Fortunately, these deformities are decreasing thanks to several parameters: patients come to the operation earlier because foot surgery has a better reputation: less invasive surgeries, therefore less painful and better controlled thanks to the raising of the level of surgeons, and to specialization. This goes hand in hand with the decrease in iatrogenics. Progress in anti-inflammatory therapies drastically reduces rheumatoid damage to the forefoot.
The therapeutic strategy for these severe deformities revolves around the notion of restoring function, the alignment of the toes, and whether or not the joints are preserved. And of course the restoration of indolence. The notion of global metatarsal shortening established by LS Barouk 25 years ago (MS point) is still valid, but the means to achieve this have evolved since percutaneous surgery of the lateral rays makes it possible to extend the indications. However, for large shortening, Weil's osteotomy is still indicated.