Interventions for treating osteoarthritis of the big toe joint

This summary of a Cochrane review presents what we know from research about the effect of interventions for osteoarthritis of the big toe joint.

The review shows that in people with osteoarthritis of the big toe joint:

A physical therapy program consisting of a standard physical therapy program (stretching and other exercises, ultrasound and electrical stimulation), plus extra mobilisation and gait training exercises, compared with a standard physical therapy program alone,

- May improve pain.

- Function was not measured.

- No harms or side effects occurred.

What is osteoarthritis and how is it treated?

Osteoarthritis (OA) is a disease of the joints. When your joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful.

Doctors used to think that osteoarthritis was caused by wear and tear on the cartilage. However, it's now thought that osteoarthritis is a disease of the whole joint. Many factors may increase your risk of getting osteoarthritis in the big toe joint, such as particular foot structure, trauma, family history of the disease, joint disease, and gait abnormalities.

OA is one of the most common forms of arthritis and affects men and women equally. OA is one of the main causes of disability as people grow older.

Interventions such as physical therapy, including exercises aim to enhance or maintain muscle strength, physical fitness and overall health. People exercise for many different reasons including weight loss, strengthening muscles and to relieve the symptoms of OA.

Best estimate of what happens to people with osteoarthritis of the big toe joint:

Pain (higher scores mean worse pain)

- People who did a standard physical therapy program plus extra exercises rated their pain to be 3.8 points lower on a scale of 0 to 10 after 4 weeks, compared with people who did standard physical therapy alone (38% absolute improvement).

- People who did a standard physical therapy program plus extra exercises rated their pain to be 0.4 points on a scale of 0-10 after 4 weeks.

- People who did a standard physical therapy program alone rated their pain to be 4.2 on a scale of 0 to 10 after 4 weeks.

Authors' conclusions: 

The reviewed trial presented a high risk of bias, which limited conclusions that could be drawn from the presented data. The inclusion of only one trial indicates the need for more robust randomised controlled trials to determine the efficacy of interventions for this condition.

Read the full abstract...
Background: 

Osteoarthritis affecting of the big toe joint of the foot (hallux limitus or rigidus) is a common and painful condition. Although several treatments have been proposed, few have been adequately evaluated.

Objectives: 

To identify controlled trials evaluating interventions for osteoarthritis of the big toe joint and to determine the optimum intervention(s).

Search strategy: 

Literature searches were conducted across the following electronic databases: CENTRAL; MEDLINE; EMBASE; CINAHL; and PEDro (to 14th January 2010). No language restrictions were applied.

Selection criteria: 

Randomised controlled trials, quasi-randomised trials, or controlled clinical trials that assessed treatment outcomes for osteoarthritis of the big toe joint. Participants of any age or gender with osteoarthritis of the big toe joint (defined either radiographically or clinically) were included.

Data collection and analysis: 

Two authors examined the list of titles and abstracts identified by the literature searches. One content area expert and one methodologist independently applied the pre-determined inclusion and exclusion criteria to the full text of identified trials. To minimise error and reduce potential bias, data were extracted independently by two content experts.

Main results: 

Only one trial satisfactorily fulfilled the inclusion criteria and was included in this review. This trial evaluated the effectiveness of two physical therapy programs in 20 individuals with osteoarthritis of the big toe joint. Assessment outcomes included pain levels, big toe joint range of motion and plantar flexion strength of the hallux. Mean differences at four weeks follow up were 3.80 points (95% CI 2.74 to 4.86) for self reported pain, 28.30 ° (95% CI 21.37 to 35.23) for big toe joint range of motion, and 2.80 kg (95% CI 2.13 to 3.47) for muscle strength. Although differences in outcomes between treatment and control groups were reported, the risk of bias was high. The trial failed to employ appropriate randomisation or adequate allocation concealment, used a relatively small sample and incorporated a short follow up (four weeks). No adverse reactions were reported.

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