Title: Sodium Hyaluronate in the treatment of Hallux Rigidus. A Single-Blind, Randomized Study
Authors: Miquel Pons MD, Fernando Alvarez MD, Jordi Solana MD, Ramon Viladot MD, Luisa Varela PhD.
Source: Foot and Ankle International. 28(1) January 2007:38-42
PODIATRIC RELEVANCE:
Hallux rigidus is the 2nd most common disorder of the first MTPJ as reported by most sources in the Orthopaedic and Podiatric literature. Current treatments for early stage Hallux Rigidus include non-operative therapies such as NSAIDS and orthotics or operative therapies such as cheilectomies and osteotomies. The objective of this study was to evaluate the effectiveness and safety of a single sodium hyaluronate (SH) vs. triamcinolone acetonide (TA) injection in the first MTPJ of patients with 1st stage hallux rigidus.
METHODS:
Thirty-seven patients (40 joints) with painful osteoarthritis of the first MTPJ with or without hallux valgus and diagnosed 1st stage hallux rigidus via clinical and radiographic examination were enrolled in this study. Inclusion criteria included pain on dorsiflexion and/or plantar flexion in the first MTPJ to a level of > 30 mm on a 100 mm visual analog scale (VAS). Exclusion criteria included patients with history of infections or previous surgeries to MTPJ, previous treatment with intra-articular injections to MTPJ, or hypersensitivity to SH or corticosteroids. Patients were randomly allocated into two groups and received a single 1.0 ml intra-articular injection of either SH or TA. All injections were done in a similar manner. Methods of assessment included the AOFAS – hallux score as well as the 100 mm VAS as the MTPJ underwent dorsiflexion and plantar flexion, palpation at rest and during gait.
RESULTS:
A significant decrease in pain via VAS was reported in both groups at rest, palpation, dorsiflexion and plantar flexion. A significant decrease in gait pain was reported by the SH group at post injection days 28 and 56. The AOFAS total score showed improvement in both groups with a significant improvement seen with the SH group at all post injection visits. Patients and investigators viewed both treatments positively with significant favoring of the SH treatment. Neither treatment caused any reported adverse events. At one year follow up 7/15 (46.6 %) patients in the SH group and 9/17 (52.9 %) in the TA group required MTPJ surgery.
COMMENTS:
The study established SH as the stronger palliative agent. Further studies investigating multiple 1.0 ml injections may show the same retarding effect on MTPJ arthritis as seen with other synovial joints treated with SH.
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Disclaimer:
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