[Proposed global treatment algorithm for hallux rigidus according to evidence-based medicine]

Good Short- and Mid-term Outcome After Cross-Linked Hyaluronic Acid Infiltration for Hallux Rigidus: A Case Report

We report a first case of hallux rigidus successfully treated in an elderly patient by intra-articular infiltration of cross-linked hyaluronic acid (HA) 21 mg/mL with mannitol (Desirial Plus) and review the previous literature on the different compositions of HA infiltrative treatment applied to hallux rigidus. A 77-year-old female patient with moderate unilateral pain of 6 months of evolution and stiffness of the movement of the first metatarsophalangeal joint of the left foot, corresponding to grade 2 of the classification proposed by Coughlin and Shurnas. The objective of the study was to perform a pilot test to (a) evaluate the correct technique of intra-articular infiltration as well as (b) the use of a commercial cross-linked HA 21 mg/mL with mannitol, to a voluntary patient diagnosed with hallux rigidus. A single cross-linked HA infiltration is applied to the first metatarsophalangeal joint with an administered amount of 1 mL. The loaded dorsiflexion, the unloaded dorsiflexion, and the unloaded plantarflexion angles of the first metatarsophalangeal joint improved from 15°, 20°, and 10°, respectively, before injection to 45°, 52°, and 22°, respectively, at 14 days after injection. Moreover, these improvements maintained until the final follow-up (400 days). The intensity of pain, according to the visual analog scale, improved from 7 of 10 before the injection, passing through 4 of 10 at 14 days after the injection, to 1 of 10 at 60 days after the injection. Cross-linked HA 21 mg/mL with mannitol improves symptomatology, joint mobility of the first metatarsophalangeal joint, and quality of life in the patient with stiff hallux submitted to the pilot test. These effects have been maintained for more than 14 months.

Hallux rigidus treated with adipose-derived mesenchymal stem cells: A case report

BACKGROUND

First metatarsophalangeal joint arthritis (FMTPA), also known as hallux rigidus, is the most frequent degenerative disease of the foot. Diagnosis is made through both clinical and radiological evaluation. Regenerative medicine showed promising results in the treatment of early osteoarthritis. The aim of the present study was to report the results of a case of FMTPA treated with the injection of autologous adipose-derived mesenchymal stem cells.

CASE SUMMARY

A gentleman of 50 years of age presented with a painful hallux rigidus grade 2 resistant to any previous conservative treatment (including nonsteroidal anti-inflammatory drugs and hyaluronic acid injections). An injection of autologous adipose-derived mesenchymal stem cells into the first metatarsophalangeal joint was performed. No adverse events were reported, and both function and pain scales improved after 9 mo of follow-up.

CONCLUSION

The FMTP joint injection of mesenchymal stem cells improved symptoms and function in our patient with FMTPA at 9 mo of follow-up.

The usefulness of a novel patient management decision aid to improve clinical decision-making skills in final year chiropractic students

Background

The process of developing patient management plans requires a series of clinical decision-making skills that can take years in practice to develop. For the inexperienced practitioner, providing a logical, systematic patient management framework may assist in clinical scenarios and accelerate their decision-making skill development. The purpose of this study was to assess whether a novel clinical management decision aid would improve the management decision-making of chiropractic students.

Methods

A prospective before and after study tracked chiropractic master degree students in their final year of study across a 10-week period from February–May, 2017. Case-based assessments were performed at baseline, after initial exposure to the decision aid, and after repeated exposure over the course of the semester. Outcome measures included the results from the 3 assessments, scored out of 20 by two markers using a standardised marking rubric, then averaged and converted to percentages; and 2 feedback questionnaires, given after initial exposure and at 10 weeks.

Results

A total of 75 students (44 males; 31 females) participated in the study. The mean score at baseline was 8.34/20 (41.7%) (95% CI: 7.98, 8.70; SD: 1.56) and after initial exposure was 9.52/20 (47.6%) (95% CI: 9.06, 9.98; SD: 2.02). The mean score after repeated exposure was 15.04/20 (75.2%) (95% CI: 14.46, 15.62; SD: 2.54). From baseline to initial exposure, there was a statistically significant absolute increase in mean score of 1.18/20 (5.9%) (95% CI: 0.6, 1.76; p < 0.0001), or a 2.82/20 (14.1%) relative improvement. From baseline to repeated exposure, there was a statistically significant absolute increase in mean score of 6.7/20 (33.5%) (95% CI: 6.02, 7.38; p < 0.0001), or a 16.06/20 (80.3%) relative improvement. The questionnaire results were also favourable. 56/75 (75%) participants agreed that the decision aid was easy to use and 46/75 (61%) of participants agreed that the decision aid improved their ability to integrate various management techniques.

Conclusion

Implementing a clinical management decision aid into the teaching curriculum helped to facilitate the ability of chiropractic students to develop patient management plans.

Electronic supplementary material

The online version of this article (10.1186/s12998-019-0278-3) contains supplementary material, which is available to authorized users.