RCT: First MTPJ Arthrodesis Lowers Walking Pain to 1.3 vs 5.7 in Hallux Rigidus

The University of Helsinki trial randomized adults 40 and older with chronic first MTPJ osteoarthritis to arthrodesis or continued observation. Primary outcome was walking pain on a 0-10 scale. At one year, surgical patients averaged 1.3 while controls averaged 5.7, with parallel gains in function, quality of life, and analgesic use. Crossover was minimal and adverse events remained within expected surgical ranges.

Arthrodesis has long been considered the reference procedure for advanced hallux rigidus yet lacked direct comparison to natural history. This trial closes that gap and aligns with observational series showing durable pain relief, though it does not address whether motion-preserving implants or osteotomies might match outcomes in milder disease.

Longer follow-up is required to determine whether radiographic nonunion or adjacent-joint degeneration erodes early gains. Head-to-head trials against cheilectomy or implant arthroplasty will clarify trade-offs between pain relief and retained motion.

Evidence quality: single-center RCT with one-year primary endpoint; adequately powered for pain but not for rare complications or subgroup effects. Next study needed: multicenter trial with five-year functional and radiographic outcomes.