Comprehensive Review of Non-Operative Management of Hallux Rigidus

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.