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Hyperpronation of Rheumatoid Foot

- Discussion:
    - hyperpronation, by virtue of its mechanics, inevitably results in hallux being forced into valgus even in absence of RA dz in first 
         metatarsal joint;
    - in this situation fusion of first MP joint is preferred option;
         - this does not apply when there is severe forefoot disease;
    - where foot has collapsed into pronated valgoid position, requirements are multiple;
    - heel is no longer under leg, midfoot is twisted, often to extent that talar head starts to bear wt medially, & gait becomes flat footed with 
         the loss of the anterior rocker;

- Treatment:
    - simple medial translational calcaneal osteotomy can help put load bearing area of heel back under loadbearing line of leg;
         - this may relieve the pain due to turning moments generated in ankle-subtaloid complex on wt bearing

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