What is a Clayton Hoffman procedure?
Clayton Hoffman procedure is a commonly performed salvage procedure for advanced rheumatoid forefoot deformity.
The rheumatoid forefoot pattern of involvement usually includes degeneration and instability at the first metatarsophalangeal (MTP) joint, leading to hallux valgus and bunion deformity.
The lesser toes are also involved with synovitis, leading to subluxation and eventual dislocation at the remaining MTP joints.
This results in prominent metatarsal heads on the plantar surface and the development of intractable plantar keratoses. This progressive deformation commonly involves all the MTP joints to some degree.
The Clayton Hoffman procedure entails resection of all the metatarsal heads through either a plantar or dorsal approach.
Rarely, only two metatarsal joints will be involved, and the procedure can be performed only on the involved joints.
An observational study reported the results at an average of five and a half years following thirty seven consecutive forefoot arthroplasties performed in twenty patients by one surgeon using a technique that is modified Hoffman procedure in the rheumatoid forefoot involving resection of all five metatarsal heads.
This study showed that resection of all five metatarsal heads in patients with metatarsalgia and hallux valgus associated with rheumatoid arthritis can be a safe procedure that provides reasonable, if rarely complete, relief of symptoms.
However, it is not recommended to remove only one or three involved metatarsal heads. Fusion of the first MTP joint is often done concurrently with the Clayton Hoffman procedure.