Table 4: Summary of therapeutic clinical trials included in this systematic review.

Study, yearDesignPEDro scoreModified PEDro scoreNumber of patientsParticipant characteristicsComplaints of patientsOutcome measuresInterventionsNumber of sessionsFollowupResult

Brantingham et al., 2007 [5]Single subject, case study2/102/5131-year-old male, golfer by professionPost traumatic big toe pain since 7 month
Grade I hallux rigidus on X-ray
NRS rating for pain score LEFI ROM of big toe extensionGraded axial elongation of MTP joint
Ultrasonic therapy graded mobilization of MTP joint
Heel raises great toe mobility and flexibility Foot flexor strengthening exercises
1 7 sessions distributed over 10 months5 monthsChiropractic interventions are helpful to reduce pain and management of hallux rigidus. RCT studies are needed to clear the interventions.
Brantingham and Wood, 2002 [21]Single subject case study1/101/5136-year-old male professional tennis playerInsidious onset of pain. Within six month pain increased to disabling limits; VAS score of pain was 10
MRI showed 80% of the foot extensor tendons had rubbed away due to spur on MTP dorsum and were repaired surgically
X-ray was not taken though the clinical diagnosis of Grade 2 Hallux rigidus was made
Pain on VAS scale Pain during playing tennis Plantar flexion strength of big toe1st session: the 1st MTP axial elongation with grade 4 mobilization at slow oscillation for 10–15 times Sessions 2–4: Same as first session
(i) Plus the HVLA thrust of MTP 3–5 times
(ii) subtalar eversion thrust
(iii) First ray planterflexion thrust
(iv) MTP dorsiflexion thrust
(v) axial elongation
After 6 session the HEP consisted of gentle dorsiflexor
ROM exercises cursive writing with toes
Total 4 treatment sessions over 2 weeks10 months
Manral, 2004 [22]Single Subject case study0/100/51Borg pain scale score 5/10
Great toe extension ROM
Borg pain scale, visualized ROM, Morton’s testChiropractic manipulative therapy, nutritional supplement, home advise of passive stretching great toe 3–5 repetition thrice a dayTotal 7 sessions over 8 weeksNot clearly mentionedQuality RCTs are needed to evaluate the effect of used interventions on hallux rigidus

Keys: NRS: numerical rating score; LEFI: lower extremity functional index; ROM: range of motion; HEP: home exercise programs; RCT: randomized controlled trial; MTP: metarso-phalangeal joint.