Dynamic splinting for postoperative hallux limitus: a randomized, controlled trial.

BACKGROUND: Hallux limitus (HL) is a pathology of degenerative arthritis in the first metatarsophalangeal joint (MTJ) of the great toe. Chief complaints of HL include inflammation, edema, pain, and reduced flexibility. The onset of HL commonly occurs after one of the two most common surgical procedures for foot pathologies, a bunionectomy or a cheilectomy. The purpose of this study is to determine the efficacy of dynamic splinting in treating patients with postoperative hallux limitus, in a randomized, controlled trial.

METHODS: Fifty patients (ages 29 to 69) were enrolled after diagnosis of HL following surgery. The duration of this study was eight weeks, and all patients received nonsteroidal anti-inflammatory drugs, orthotics, and instructions for a home exercise program. Experimental patients were also treated with dynamic splinting for first MTJ extension (60 minutes, three times per day). The dependent variable was change in active range of motion (AROM). A repeated measures analysis of variance was used with independent variables of patient categories, surgical procedure (cheilectomy vs. bunionectomy) and duration since surgery.

RESULTS: There was a significant difference in change of AROM for experimental vs. control patients (P < 0.001, T = 4.224, N = 48); there was also a significant difference for patient treated within 2 months of surgery (P = 0.0221).

CONCLUSIONS: Dynamic splinting was effective in reducing contracture of postoperative hallux limitus in this study; experimental patients gained a mean 250% improvement in AROM. This modality should be considered for standard of care in treating postoperative hallux limitus.