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What are the benefits and risks of non-surgical treatments for osteoarthritis of the big toe joint?
The use of arch-contouring foot orthoses provided similar effectiveness to sham inserts for improving foot pain, function and quality of life in people with big toe osteoarthritis, with a similar risk of adverse events.
The use of shoe-stiffening inserts provided similar effectiveness to sham inserts for improving foot pain, function and quality of life in people with big toe osteoarthritis. The magnitude of the difference between groups approached statistical significance if shoe-stiffening inserts were used with rehabilitation therapy (0.5 worse to 13.1 better on a 100-point scale). There were no differences in the risk of adverse events.
A single intra-articular injection of hyaluronic acid offered no benefit when compared with placebo injection for improving foot pain, function, quality of life or big toe range of motion in people with big toe osteoarthritis, with a similar risk of adverse events.
The quality of the evidence in this review is limited by the risk of bias in reported outcomes and the small number of included trials, with evidence for each intervention arising from single trials. In addition, only 2 of the 6 trials evaluated the interventions for longer than 12 weeks, and considering osteoarthritis is a chronic long-term condition, this is a major limitation.
Osteoarthritis affecting the first metatarsophalangeal joint (hallux rigidus) is common and painful. Several non-surgical treatments have been proposed; however, few have been adequately evaluated.
Munteanu SE, et al. Non-surgical interventions for treating osteoarthritis of the big toe joint. Cochrane Database Syst Rev 2024;6:CD007809. This review contains 6 trials, which included 547 people.
Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality
