Outcomes in Hallux Rigidus Patients Treated Nonoperatively: A Long-Term Follow-Up Study

Abstract

The purpose of this study was to analyze radiographic outcome and patient satisfaction in non-operative care of hallux rigidus. Twenty-two patients representing 24 feet were surveyed and radiographed. Average follow-up was 14.4 years (range, 12-19 years). In 75% (18/24) of the feet, the patients would "still chose not to have surgery" if they had to make the decision again. The pain remained about the same in 22 feet, improved with time in one, and became worse in one. The most common reason given for not having surgery was that the pain was not severe enough. The most common type of self-care was a shoe with an "ample toe box." More patients benefited from a stiff sole than a soft sole, but the majority of patients did not cite the sole of the shoe as being important. There was measurable loss of cartilage space radiographically over time in 16 of 24 feet, and in eight of the 16 feet, the loss of cartilage space was dramatic. The majority of hallux rigidus patients rated their pain as staying the same over a twelve-year period, despite significant deterioration of joint space noted radiographically.

Hallux rigidus: A case report of successful chiropractic management and review of the literature

“…There may be dorsal and marginal osteophytes in the related bones and joints and they may also be seen in adjacent regions as in the case in question. Late stages may show loss of joint space, sclerosis, joint irregularities and cysts (7,8,11). The literature does not recommend advanced imaging studies and lab studies.…”

“…But, most of the literature concerning HR focuses on the operative management of the disease (11,12). Conservative management works best in early or uncomplicated stages (ie, grades 0 to 2).…”

“…Mild cases do not require any treatment or may require symptomatic treatment at most. Therefore, conservation treatment is worth a trial first (4,7,11).…”

“…Also, it is recommended that the shoe should be larger than before and the leather should be softened dorsally over the MTP. The use of orthotics with medial stiff shank or bar is also helpful to correct pronation (4,8,9,11,12). The second important measure in conservative management in the modification of the patient activities that may include avoidance of situations that can lead to an extreme dorsiflexion of the great toe (eg, kneeling or squatting with toes) (12).…”

“…• Presence of a large dorsal metatarsal head osteophyte without significant pain (except with shoe pressures) • Refractory cases to concervative treatment (11,12).…”