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Manipulation and injection for hallux rigidus. Is it worthwhile?

M C Solan1, J D Calder, S P Bendall

  • 1Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Haywards Health, West Sussex, England.

The Journal of Bone and Joint Surgery. British Volume
|July 31, 2001
PubMed
Summary

Manipulation and steroid injections offer temporary relief for hallux rigidus, especially in early stages. This treatment is less effective for advanced cases, with most patients eventually requiring surgery.

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Area of Science:

  • Orthopedics
  • Podiatry
  • Sports Medicine

Background:

  • Manipulation and corticosteroid injections are common treatments for hallux rigidus.
  • Limited data exists on the long-term outcomes of this intervention.

Purpose of the Study:

  • To evaluate the effectiveness of manipulation and injection for hallux rigidus based on disease severity.
  • To provide evidence-based recommendations for the clinical application of this treatment.

Main Methods:

  • A retrospective study of 37 hallux rigidus joints treated with manipulation and corticosteroid/local anesthetic injection.
  • Minimum follow-up of one year (mean 41.2 months).
  • Patients were categorized by hallux rigidus grade (mild, moderate, advanced).

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Main Results:

  • Mild (Grade 1) hallux rigidus: Median symptomatic relief of 6 months; one-third required surgery.
  • Moderate (Grade 2) hallux rigidus: Two-thirds proceeded to open surgery.
  • Advanced (Grade 3) hallux rigidus: Minimal symptomatic relief; all patients required operative treatment.

Conclusions:

  • Joint grading is crucial before treatment for hallux rigidus.
  • Manipulation and injection are best suited for early-stage (Grades 1 and 2) hallux rigidus.
  • This approach may delay but not eliminate the need for surgery in advanced disease.