Comprehensive Review of Non-Operative Management of Hallux Rigidus

Abstract

This article aims to provide an evidence-based literature review for the non-operative management of hallux rigidus. Currently, there is very little article on the evidence for the non-operative management of hallux rigidus. A comprehensive evidence-based literature review of the PubMed database conducted in November 2016, identified 11 relevant articles out of 560 articles assessing the efficacy of non-operative modalities for hallux rigidus. The 11 studies were then assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against the non-operative modality. Based on the results of this evidence-based review, there is poor evidence (grade C) to support use of intra-articular injections for pain relief for a period of three months and fair evidence (grade B) against the use of intra-articular injections for long term efficacy. There is poor evidence (grade C) to support manipulation and physical therapy and poor evidence (grade C) to support modifications in footwear, insoles and orthotics. There were no good evidence (grade A) recommending any interventions. In general, most of the interventions showed improvement. However, the evidence is poor in recommending orthosis, manipulation and intra-articular injections. There is a need for high-quality Level I randomized controlled trials with validated outcome measures to allow for stronger recommendations to be made. There is no study that looked solely at the use of pharmaceutical oral agents for the treatment of hallux rigidus. Non-operative management should still be offered, prior to surgical management.

Complex approach to the conservative treatment of hallux rigidus

“…Консервативное лечение ОА ПФС1 является сложной проблемой, требующей доказательного и структурированного подхода с применением патогенетически обоснованных методик. Стоит отметить отсутствие в отечественной и зарубежной литературе достаточного количества высококачественных научно обоснованных работ, посвященных данной проблеме, что может быть связано с различиями в методологии оценки и классификации выраженности ДД изменений в ПФС1, отсутствием стандартного протокола применяемых методик восстановительного лечения и недостатком информации относительно частоты и длительности проводимых мероприятий [23,27,28,29].…”

“…Основываясь на современных литературных данных, можно заключить, что на сегодняшний день не существует консервативного метода, позволяющего достичь стойкого положительного результата на различных стадиях ОА ПФС1, что во многом связано с отсутствием комплексного подхода к диагностике и лечению заболевания [23,24,25]. До сих пор нет единого мнения о необходимости медикаментозного лечения, использования специальной ортопедической обуви и ортопедических стелек, применения физиопроцедур и физических методов восстановления.…”

A systematic review of injectable corticosteroid for osteoarthritis of the first metatarsophalangeal joint 

“…A recent review [14] that set out to provide comprehensive list of evidence-based recommendations regarding conservative treatment modalities for 1 st MPJ OA included a review of injection therapy. Authors of the review found 'fair evidence' to support the use of IA CSIs to treat 1 st MPJ OA.…”

“…Numerous narrative reviews exist regarding treatments for hallux rigidus and include CSIs but provide no evidence-based recommendations for treatment. An exception to this was a comprehensive review [14], the aim of which was to provide evidence-based recommendations regarding conservative treatment modalities for hallux rigidus and included a review of injection therapy. Authors of the review based their recommendations on an established appraisal system [23] that allocates a level of evidence for an intervention based on the design of studies identi ed.…”

“…Which patients are most likely to bene t from this treatment? What is the frequency with which corticosteroid should be administered and whether the use of ultrasound guided injections improves treatment outcomes [12,13,14]. Furthermore, there has been debate surrounding whether a steroid based solution when combined with local analgesia may even be chondrotoxic [15].…”