We present a retrospective study on the outcome of Clayton’s forefoot arthroplasty in 23 patients with rheumatoid arthritis.

The average age at surgery was 51.2 years (range 26–88). Pre-operative symptoms were pain, deformity, and footwear problems. Hallux valgus, lesser toe deformities and callosities were the common signs. One surgeon performed all procedures. All patients were assessed radiologically and clinically using American Orthopaedic Foot and Ankle Society (AOFAS) rating system.

Thirteen patients had bilateral correction, and 10 had single foot surgery, providing a total of 36 feet for analysis. Complications included eight wound infections, two toe tip ulceration, two ischaemic toes and two painful feet.

The AOFAS average score was under 45 before surgery and it improved to 83 (range 47–100) for hallux and 79 (range 40–100) for the lesser toes. Overall 91% patients were pleased with the procedure. Our results suggest that Clayton’s forefoot arthroplasty is a procedure, which provides predictable comfort and immediate, functional improvement in advanced rheumatoid arthritis.