Methods (case study):
A 31-year-old male professional golfer presented with a complaint of big toe pain of 7 months’ duration. After history, physical and regional evaluation, and radiography of the right foot and big toe, a diagnosis of Grade 1 hallux rigidus was made. Management of the patient included chiropractic adjusting of the first MTPJ using graded axial elongation, mobilization of the sesamoids, adjustment of additional foot and ankle joint dysfunction, big toe and foot flexor strengthening and stretching exercises, and ultrasound. Outcome measures included the Lower Extremity Functional Index (LEFI), Numerical Rating Scale (NRS) and goniometric range of motion (ROM). The patient received 17 visits over 10 months.
The initial NRS was 6, and on the final visit was 0–1. Initial goniometer ROM of the big toe in passive dorsiflexion was 45° and on the final visit was 84°. The LEFI had a score of 22% on the initial visit and 2% on the final visit. Substantial improvement was noted after the first treatment and in fact the patient did not return for further treatment for 5 months. Slowly, mild big toe pain and stiffness returned and the patient came back, and remained compliant with treatment. Steady and substantial improvement occurred after his return. Although an occasional mild increase in symptoms occurs after prolonged practice or play, he has resumed normal professional activities with no restrictions and is pleased with treatment outcome.
Conclusion: Natural history, a desire to please the doctor and lack of control does not allow extrapolation of these findings to the general population. Nevertheless, in this patient, chiropractic adjusting, foot flexor strengthening and ultrasound was effective in treatment of hallux rigidus. Randomized controlled trials are needed.
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