Manipulation and injection for hallux rigidus

Abstract

Hallux rigidus is a common condition with an estimated incidence of 1 in 40 in subjects aged over 50 years. Plain radiographs may show flattening of the distal articular surface of the first metatarsal, a narrowed joint space, osteophytes on the medial, lateral and dorsal aspects of the metatarsal head and proximal phalanxi with sclerosis and cyst formation in the subchondral regions as the condition advances. These radiological changes have been divided into mild (grade 1), moderate (grade 2) and severe (grade 3) ( Table I). Non-operative treatment includes the use of non-steroidal anti-inflammatory agents, and orthoses which aim to reduce the movement that produces pain. Surgical treatment includes resection arthroplasty, metal or ceramic hemiarthroplasty, silastic interposition arthroplasty, softtissue interposition arthroplasty, metatarsophalangeal arthrodesis, phalangeal and metatarsal osteotomy, cheilectomy and arthroscopic debridement.

Efficacy of Foot and Ankle Corticosteroid Injections

“…Approximately a third of patients with midfoot or hindfoot arthritis may continue to have benefit from the injection for longer than 6 months; this was not the case for patients with hallux rigidus, where few had improvement for greater than 3 months. This would concur with a previous study by Solan et al, 30 which concluded that injections for hallux rigidus should be reserved for those patients with only mild arthritis.…”

Foot osteoarthritis: latest evidence and developments

“…Manipulation may also be performed in conjunction with corticosteroid and local anaesthetic injection for first MTP joint OA, although the therapeutic benefits of this technique appear to be limited to milder forms of the condition. Solan and colleagues 74 reported that patients with mild OA obtained symptomatic relief for a median of six months, and only one-third required surgery. However, in more advanced cases, little symptomatic relief was obtained and all patients eventually required surgery.…”

Current Concepts Review: Hallux Rigidus

“…A custom orthoses with a navicular pad and Morton's extension will restrict motion also. While biomechanical studies have shown that functional orthoses can either restrict dorsiflexion in a painful joint or conversely increase dorsiflexion for earlier stages of hallux rigidus, no clinical correlation has been demonstrated 44,73 (Level V evidence). One clinical study found that 47% of patients responded to custom orthoses alone, while another 10% responded to simple shoe modifications 34 (Level IV evidence).…”