Hallux rigidus: are only injections worth it?—a systematic review

Background: The term hallux rigidus describes the painful condition of the metatarsophalangeal joint of the great toe, characterized by restricted motion and proliferative osteophytosis. Conservative treatments are typically used. In certain cases, a carefully administered intra-articular steroid injection may provide temporary relief. Very few studies have been reported in the literature; thus, data on the efficacy of these injections are limited. For this systematic review of the literature, we asked: (I) what injection treatment options are available for hallux rigidus? (II) What are the success rates and outcomes of these treatments? (III) Which factors influence the outcomes? (IV) How long have the effects of the injection lasted? Methods: In January 2025 a search was conducted on the electronic databases PubMed, Scopus, and Embase using the search terms: “hallux rigidus” or “hallux limitus” and “injection” or “steroid” or “ialuronic” or “platetel-rich plasma”. Inclusion (English language, treatment of hallux rigidus/limitus with injections) and exclusion criteria (injection involving other joints, descriptive or epidemiological studies, and systematic reviews) were determined a priori. The ROBINS-I was used to assess the risk of bias in each report. In addition, studies with injections after hallux surgery were excluded, aiming to understand whether injections for the hallux rigidus are truly. Results: The final review included thirteen studies, whose quality was rated as moderate. High success rates for pain relief (84–92%) and movement restoration have been reported; the reduction in visual analogic score (VAS) scores after injection was statistically significant, regardless of the substance used (P<0.05). Some factors may influence the effectiveness of injections: the severity of osteoarthritis and imaging guidance are demonstrated to be significant; contrarily, the type of injection is not crucial, even if hyaluronic acid may provide better long-term benefits. The duration of efficacy has been reported to be less than one-year in 50% of patients. Conclusions: Intra-articular injections of hallux rigidus are effective and safe for conservative treatment of hallux rigidus, particularly in the early stages of osteoarthritis.