Manipulation and injection for hallux rigidus - Is it worthwhile?

Manipulation of the metatarsophalangeal joint and injection with steroid an d local anaesthetic are widely practised in the treatment of hallux rigidus , but there is little information on the outcome, We report the results of this procedure carried out on 37 joints, with a minimum follow-up of one ye ar (mean, 41.2 months). Patients with mild (grade-l) changes gained symptom atic relief for a median of six months and only one-third required surgery. Two-thirds of patients with moderate (grade-2) disease proceeded to open s urgery. In advanced (grade-III) hallux rigidus, little symptomatic relief w as obtained and all patients required operative treatment. We recommend tha t joints are graded before treatment and that manipulation under anaestheti c and injection be used only in early (grades I and II) hallux rigidus.