Which forefoot deformity is commonly seen in rheumatoid arthritis?

• A. Hallux valgus
• B. Flatfoot
• C. Pes planus
• D. Hammertoe with forefoot splaying

Answer: (D)

Rheumatoid arthritis causes inflammatory synovitis in the small joints of the forefoot, especially the metatarsophalangeal joints, leading to destruction of cartilage and supporting ligaments. This destroys stability at the forefoot, so the metatarsals and toes drift apart and the forefoot widens—this is forefoot splaying. At the same time, imbalances among the toe flexors and extensors after joint destruction produce flexion deformities at the toe joints, classically described as hammer toe. The combination—hammer toe with forefoot splaying—captures a characteristic RA forefoot pattern driven by joint destruction and ligamentous laxity. While hallux valgus or flatfoot can occur in RA, the pattern that best reflects forefoot involvement in RA is hammer toe with forefoot splaying.