Surgery better than waiting for pain reduction in patients with hallux rigidus

Surgical intervention with first metatarsophalangeal joint (MTPJ) arthrodesis significantly reduces pain associated with walking compared with watchful waiting among adults with painful hallux rigidus, a study has shown.

This single-centre, parallel-group, randomized, controlled, superiority trial was conducted in the orthopedic department of a tertiary care hospital in Finland.

Adults aged ≥40 years with radiographically confirmed hallux rigidus with symptoms over a year and a walking pain score of ≥4 on a numerical rating scale (NRS) were included in the study. Those with type 1 diabetes mellitus, rheumatoid arthritis, and hallux valgus angle >15° were excluded.

Ninety participants (mean age 58.1 years) were randomized to surgery with first MTPJ arthrodesis using lag-screw and dorsal plating (n=45) or watchful waiting (n=45) between November 2021 and June 2024.

Of the participants, 89 completed the 12-months follow-up. The observed mean walking-related pain at 12 months was significantly lower in the surgery group than the watchful waiting group: NRS, 1.3 vs 5.7; adjusted mean difference, ‒5.0 points, 95 percent confidence interval, ‒6.1 to ‒3.9. This exceeded the prespecified minimal clinically important difference of 1.7 points and favoured arthrodesis.

The study was limited by its single-centre design.

“Hallux rigidus, or osteoarthritis of the first MTPJ, causes pain and functional limitation,” the investigators said.