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.

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.

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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