Hallux Rigidus Update on Conservative Management

There is a place for initial conservative treatment in most patients with hallux rigidus, understanding that there are limitations. These treatment options should be recommended in a tailored fashion based on patients' expectations and clinical and radiological findings. There is clearly a consensus that no conservative treatment can limit the degenerative evolution of the disease. Patients with a tolerable pain level may find a stabilization of their pain with conservative measures, despite worsening of their radiographic findings. For patients with high-grade degenerative changes and severe symptoms, there is no evidence to support a long lasting and efficient pain level reduction with injections, shoes modifications, or orthotics. These measures may stabilize the pain level over time but are unlikely to provide significant improvement. For patients with mild or moderate pain and degenerative changes, corticosteroid injections and shoe modification may provide pain relief for 3 to 6 months with long-lasting effect (>1 year) in only a limited number of patients. There is little evidence to support HA over corticosteroid in most patients; however, patients with mild degenerative changes, who are willing to have repeated injections on a short period of time, may benefit from HA as an alternative. There is no clear evidence to support physical therapy, and there is no specific protocol to follow. Most of the physical therapy protocols are based on the experience and habits of the physical theraptist.35 35 There is a clearly a need for a better understanding of the etiology of the disease, to propose more efficient conservative treatment for patients who are either not eligible for surgery or reluctant to undergo a surgical treatment. This would also help to slow down the evolution of this degenerative condition.