The level of evidence is downgraded by study quality (several issues) and imprecise results.
A Cochrane review [Abstract] 1 included only 1 study with a total of 20 subjects. Most studies evaluated for review included patients with hallux rigidus and hallux valgus with pooled results, and were thus excluded. The only quasi-randomised trial included evaluated the effectiveness of two similar physical therapy treatment regimes in 20 individuals (control group n=10; intervention group n=10) with big toe joint pain, loss of motion and muscle weakness. The control group performed the following physical therapies three times weekly for four weeks (12 sessions): whirlpool bath, calf and hamstring stretches, pulsed ultrasound, passive range of motion exercise, dorsal glides and distraction of the first MPJ, seated heel raises, picking up marbles with toes, electrical stimulation, application of cold packs and a home exercise program. The experimental group performed the same physical therapies prescribed to the control group and additionally received the following: sesamoid mobilisations, hallux strengthening, gait retraining and isometric muscle contractions. 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.
Date of latest search: 2010-09-08
Primary/Secondary Keywords