Hoffman-Clayton Procedure for Forefoot Arthritis and Fat Pad Atrophy
As a young doctor, the Hoffman, or what some doctors call a Hoffman-Clayton procedure seem so darned aggressive. I was often reluctant to recommend a Hoffman procedure due based upon the assumption that the procedure was a joint destructive procedure. Over the course of my career though, I’ve seen the Hoffman procedure make a significant difference in many patient’s lives. As a result, I do tend to recommend Hoffman procedure more now that I would have int he past.
The two primary indications for a Hoffman procedure are joint subluxation secondary to rheumatoid arthritis and fat pad atrophy. Both conditions result in severe pain on the plantar forefoot. Many patients present with focal areas of callus that result in severe pain. In the early stages of these forefoot problems, patients can be accommodated with a metatarsal pad, metatarsal bar on the shoe or the use of a forefoot rocker on the shoe. But I’ve tended to find that for active patients, these modifications are going to be limited in their efficacy. These modifications are best for those folks who lead a limited level of activity. And example of limited activity would be a person who ambulates with a walker.
A Hoffman procedure involves the resection of metatarsal heads 2-5. A Hoffman-Clayton procedure is a resection of the metatarsal heads and bases of the proximal phalanges. In my hands, I tend to stick with the Hoffman procedure, leaving the phalangeal bases intact.
A Hoffman procedure does need to be performed in a hospital setting with either a general anesthetic or local anesthetic with sedation. A Hoffman can be performed on an outpatient basis. Most patients return to a loose fitting shoe at about 3-4 weeks post-op.
Fat pad atrophy and rheumatoid forefoot deformities can be difficult to manage conservatively. Although conservative care is a must, when conservative care fails, don’t forget about that old school procedure, The Hoffman procedure.
Jeffrey A. Oster, DPM
The Cherry Valley Foot and Ankle Center
Newark, Ohio
Dr. Oster cannot answer medical questions or provide medical care through this blog.
Tags: capsulitis forefoot, fat pad atrophy, forefoot pain, rheumatoid arthritis deformities
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