Proposed global treatment algorithm for Hallux rigidus according to evidence-based medicine

Herrera-Pérez, Mario; Andarcia-Bañuelos, C.; Bergua-Domingo, J. de; Paul, Jochen; Barg, Alexej; Valderrábano, Víctor

doi:10.1016/j.recote.2014.09.006

Cited by 4 publications

(6 citation statements)

References 44 publications

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“…However, it seems advisable to start this therapy before evaluating the possibility of surgical treatment, because conservative treatment is apparently effective in at least 50% of patients (3) . There is a moderate grade of recommendation for footwear modifications, use of custom plantar orthoses, and injections (1)(2)(3)19) . It was not possible to demonstrate the usefulness of either anti-inflammatory or analgesic drugs, or of manual therapy (physical therapy) in any of its modalities (1) .…”

Section: Injectionsmentioning

confidence: 99%

“…There is a moderate grade of recommendation for footwear modifications, use of custom plantar orthoses, and injections (1)(2)(3)19) . It was not possible to demonstrate the usefulness of either anti-inflammatory or analgesic drugs, or of manual therapy (physical therapy) in any of its modalities (1) .…”

Section: Injectionsmentioning

confidence: 99%

“…Although different therapeutic alternatives have been described, high quality scientific evidence is scarce (1)(2)(3)(4)(5) . However, most clinical guidelines recommend initiating conservative treatment, since it is effective in approximately half of the patients (3) .…”

Section: Introductionmentioning

confidence: 99%

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Conservative treatment of hallux rigidus: narrative review of scientific evidence

et al. 2021

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This study proposes an update on conservative treatment of hallux rigidus based on scientific evidence. This is a narrative review of 19 articles that analyzed conservative treatment of hallux rigidus in its different modalities. Conservative treatment is effective in approximately half of the patients with hallux rigidus, and footwear modifications, use of insoles, and hyaluronic acid injections are the most effective treatments, according to evidence-based medicine. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.

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Section: Injectionsmentioning

confidence: 99%

Section: Injectionsmentioning

confidence: 99%

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Conservative treatment of hallux rigidus: narrative review of scientific evidence

et al. 2021

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“…5 The joint replacement with an implant is one of the various forms of surgical treatment for advanced stages of the pathology hallux rigidus. 6–9 These implants are press-fitted into the medullary canals and restore joint movement, alignment and improve the quality of life of patients. However, the stiffness of elastomers used for manufacture may reduce the movement of the joint and grip strength.…”

Section: Introductionmentioning

confidence: 99%

Structural assessment of pre-flexion in silicone implants for arthroplasty of the first metatarsophalangeal joint

Campos

Lesso

Bayod-López

et al. 2022

Proc Inst Mech Eng H

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The development of numerical models to analyze pathologies and implants related to the first metatarsophalangeal joint of the foot remains an issue for attention. The structural effects of implants pre-flexion have been discarded in several finite elements analyses due to complexities to achieve these positions. This work aims to evaluate if the pre-flexion stress state should be included or could be discarded when only flexion is applied in two different silicone commercial implants, Swanson and Tornier, during a gait cycle. Finite element models were created for silicone implants. Both models were discretized using high-order finite elements. The hyperelasticity constitutive material model of Arruda-Boyce was used, based on experimental data; its behavior was compared with linear elastic models reported and used frequently assuming small and large deformations and applying to the Swanson and Tornier implants a flexion angle of 64°, which corresponds to in vivo measurements reported after implantation. Comparison between models, regarding hyperelastic model, showed mean variations of up to 32.5% for stresses and 14.01% for bending moment in Swanson implant, while for Tornier implant mean variations of 29.73% and 632.55% was obtained for stress and bending moment respectively. The maximum stress value obtained for the hyperelastic model in the Swanson implant reached a value of 22.82% of the tensile strength of the implant material while in the Tornier implant reached a value of 25.92%, the above values were evaluated at a flexion angle of 64°. The results suggest considering in finite element analyses not only the stress state generated to achieve critical flexion position in pleflexed implants models but also the hyperelastic material behavior of silicone for implants to avoid dismissing the non-linear structural behavior of hyperelastic materials.

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“…Hallux rigidus, or arthrosis of the first metatarsophalangeal joint (MTPJ), is the most frequent arthrosis of the foot, affects 2.5% of the population older than 50 years (1) , and has 4 evolutionary stages described (mild-moderate: I and II; moderate-severe: III and IV). This article aims to present a global algorithm for the treatment of this disease, both conservative and surgical, following the principles of a similar study published in 2014, adding new evidence from the last 7 years (2) .…”

Section: Introductionmentioning

confidence: 99%

Proposed treatment algorithm for hallux rigidus

Herrera-Pérez

González-Martín

Pericé³

2021

J Foot Ankle

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This study performs a literature review on the treatment of hallux rigidus and proposes a treatment algorithm.This literature systematic review expanded a similar study conducted in 2014 by the authors and analyzed the levels of recommendation according to scientific evidence.Most articles found in the search present scarce evidence (level IV or case series), we only found 8 articles with an at least moderate level of recommendation (B); of these, only one article had a level of evidence I.Conservative treatment is effective with the implementation of footwear modifications, use of insoles, and infiltrations with hyaluronic acid. Cheilectomy, either isolated or combined with Moberg osteotomy, shows good outcomes in stage III, or moderate, although its outcomes worsen after 5 years. Metatarsophalangeal joint (MTPJ) arthrodesis is still the gold standard in stage IV, or advanced. In recent years, the technique of interposition arthroplasty has re-emerged, especially with the use of a synthetic cartilage implant (Cartiva®), with outcomes at least similar to those of MTPJ arthrodesis in comparative studies. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.

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Proposed global treatment algorithm for Hallux rigidus according to evidence-based medicine

Cited by 4 publications

References 44 publications

Conservative treatment of hallux rigidus: narrative review of scientific evidence

Conservative treatment of hallux rigidus: narrative review of scientific evidence

Structural assessment of pre-flexion in silicone implants for arthroplasty of the first metatarsophalangeal joint

Proposed treatment algorithm for hallux rigidus

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