Prolotherapy for Bunions | Metatarsophalangeal Joint Pain

Prolotherapy for Bunions | Metatarsophalangeal Joint Pain

Ross Hauser, MD

A bunion is an enlargement of the joint at the base of the big toe (the metatarsophalangeal or MTP joint) that forms when the bone or tissue moves out of place. The toe bends inward at an awkward angle, which usually creates a large bony lump. If not treated, bunions can become very painful since this area supports a lot of body weight. The MTP joint can also become sore and stiff. Bunions can occur on the outside of the little toe as well.

The metatarsophalangeal joint (MTP), formed by the metatarsal and phalangeal bones of the toes, is the location of common foot degenerative problems.

The two most prevalent sources of pain in the MTP joint are the conditions of hallux valgus, a precursor to bunions, and hallux rigidus, stiffness in the big toe.

A well-researched etiology (cause) for these conditions is ligament laxity.

In our published research in The Foot and Ankle Online Journal (FAOJ) we presented twelve patients were treated with a series of Dextrose Prolotherapy injections to stimulate the regeneration of tendons and ligaments and to promote the repair of articular cartilage.

Upon completion of three-to-six therapy sessions, eleven of twelve patients had a favorable outcome—the relief of symptoms—with an average of four treatments.

Based on such positive, verifiable results, Prolotherapy can be viewed as a promising alternative to steroid injection, surgical repositioning (e.g., chevron osteotomy), or joint replacement.

All the patients in this study had had some other form of therapy before Prolotherapy. Among conventional therapies, surgery is often prescribed for hallux valgus and the resulting bunions.

In December 2016, doctors in the Czech republic published troubling finding on bunion surgery in the medical journal Clinical Biomechanics.

  • The aim of the study was to compare lower limb and pelvis movement during walking in patients with hallux valgus before and after surgery.
  • Seventeen females with hallux valgus, who underwent first metatarsal osteotomy (bone shaving), constituted the experimental group.
  • The results showed that after hallux valgus surgery:
    • the walking speed decreased even more
    • Asymmetry in the hip and the pelvis movements in the frontal plane (present preoperatively) persisted after surgery.
  • Conclusion: Hallux valgus is not an isolated problem of the first toe, which could be just surgically addressed by correcting the foot’s alignment.1

A paper in the April 2017 edition of the journal Arthroscopy techniques suggests that “the underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure.”2

In other words, the surgeon did not address the problem causing the hallux valgus deformity and the patient is predisposed to factors of degenerative joint disease. In our opinion these are the tell-tale signs of degenerative joint disease from joint instability from ligament weakness. Surgery does not address ligament weakness.

Prolotherapy for bunions

Research like that above and due to a lack of consensus on the efficacy of surgery and other conservative treatments, patients are considering alternative methods, including Prolotherapy. Because first MTP joint pain is difficult to manage, this study investigated Dextrose Prolotherapy injections in order to establish the efficacy of this treatment with a study group and, subsequently, with patients afflicted with several painful conditions.

Bunions are an overgrowth of bone at the first metatarsophalangeal joint caused by degenerative joint disease from joint instability from ligament weakness. When ligaments weaken, the bones move. This is visually evident because bunions are a result of a gross displacement of the bone. Bone movement due to ligament laxity causes the bones to hit each other. This hitting causes an overgrowth of bone, as an attempt to stabilize the joint.

In our study patients complaining of diffuse big toe pain were treated with Prolotherapy. In the days following the procedure, patients were allowed to return to normal non-strenuous activities. Patients were advised to avoid such medications as ibuprofen, which block the inflammatory process. However, we did approve of the use of acetaminophen-based analgesia. Patients returned for treatment every four weeks, depending on their schedule, completing from 3 – 6 treatments.

  • After receiving injections, patients reported significant reduction in pain and stiffness.
  • Patients were asked to rate their pain levels on a scale of 0 to 10, with 0 being no pain and 10 being severe crippling pain.
  • All 12 patients reported pain as a symptom. Thus, patients were asked to report pain levels before and after Prolotherapy in these three categories:
    • 1) pain at rest,
    • 2) pain with normal activities, and
    • 3) pain with exercise.
  • Concerning 1) pain at rest: prior to Prolotherapy treatment, pain measurement scores averaged 4.42./10. After Prolotherapy treatment, pain measurement scores averaged less than 1/100th . Only one patient reported a VAS pain level of 1, and all others reported zero.
  • Concerning 2) pain with normal activities: prior to Prolotherapy treatment, pain measurement scores averaged 6.50.
    • Five of 12 patients could walk less than fifty feet without pain; seven of 12 could not walk a half-mile without pain; and ten of 12 could not walk a full mile.
    • After Prolotherapy, all but one patient reported no restrictions in walking any distance without pain, and a pain measurement average score of 1.17 was noted.
  • Concerning 3) pain with exercise: prior to Prolotherapy, five of 12 patients reported being severely compromised (only 0 to 30 minutes possible) in their ability to exercise, and a pain measurement scores of 7.42.
    • Of the twelve patients, two were totally compromised and unable to exercise; three were moderately (only 30 to 60 minutes possible).
    • Over half of the patients were severely to totally compromised in their athletic abilities prior to treatment.
    • After Prolotherapy, seven of 12 patients reported being able to exercise as much as they wanted without impediments and with satisfaction.

When comparing the three previous categories before and after Prolotherapy, all reached a statistically significant outcome.

Thus, this retrospective study, without a control group, demonstrates that Prolotherapy decreases pain and improves the quality of life for patients with metatarsophalangeal joint pain—unresolved by previous therapies, medications, and interventions.

As a result of Prolotherapy, eleven of 12 patients reported a greater than 75% improvement in the activities of daily living that continued to the end of the study. Of the two patients who were told they needed surgery, both felt sufficient pain relief with Prolotherapy to avoid surgery. After the study period, patients experienced overall improvement in range of motion, ability to walk and exercise, as well as relief of stiffness and numbness/burning.

Questions about Bunions and Metatarsophalangeal Joint Pain? Get help and inflammation from our Caring Medical staff 

1 Klugarova J, Janura M, Svoboda Z, Sos Z, Stergiou N, Klugar M5. Hallux valgus surgery affects kinematic parameters during gait. Clin Biomech (Bristol, Avon). 2016 Dec;40:20-26. doi: 10.1016/j.clinbiomech.2016.10.004. Epub 2016 Oct 6. [Pubmed] [Google Scholar]

2. Lui TH. Correction of Recurred Hallux Valgus Deformity by Endoscopic Distal Soft Tissue Procedure. Arthroscopy techniques. 2017 Apr 30;6(2):e435-40. [Pubmed] [Google Scholar]

 

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