What are the treatment options for Interphalangeal Joint (IPJ) valgus deformity?

From the Guidelines

Treatment for Interphalangeal Joint (IPJ) valgus deformity should prioritize conservative measures, including education, exercises, and orthoses, before considering surgical options like arthrodesis or arthroplasty, as recommended by the 2019 EULAR guidelines 1. When managing IPJ valgus deformity, it's essential to consider the patient's overall health, functional needs, and the severity of the deformity.

• Initial treatment focuses on pain management and joint protection, which can include topical NSAIDs as the first pharmacological treatment of choice, according to the EULAR guidelines 1.
• Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient, with a level of evidence 1a and grade of recommendation A 1.
• Orthoses can be considered for symptom relief, particularly for patients with thumb base OA, but may also be beneficial for IPJ valgus deformity, with a level of evidence 1b and grade of recommendation A 1. If conservative measures fail to provide relief,
• intra-articular injections of glucocorticoids may be considered in patients with painful interphalangeal joints, although this is recommended with a level of evidence 1b and grade of recommendation A, and should be used judiciously 1. For severe cases or when conservative treatments are ineffective,
• surgical options like arthrodesis or arthroplasty may be necessary, with the choice of treatment depending on the severity of the deformity and the patient's overall health and functional needs, as recommended by the EULAR guidelines with a level of evidence 5 and grade of recommendation D 1.

From the Research

Treatment Options for Interphalangeal Joint (IPJ) Valgus Deformity

• Surgical options:
  • Medial closing wedge osteotomy and fixation with a double compression headless bone screw (DCHBS) 2
  • Great toe interphalangeal fusion using Kirschner wire fixation or a single retrograde cannulated screw 3
• Conservative treatments:
  • Combination of exercise and toe separator, night splints, and dry needling 4
  • Kinesiotaping to reduce pain and improve joint alignment 5
  • Custom-fabricated orthoses, such as synthetic serial casting and static-progressive splinting, to treat PIPj flexion contractures 6

Key Considerations

• The choice of treatment depends on the severity of the deformity, patient age, and presence of other foot or toe deformities 4, 3
• Conservative treatments may be effective in reducing pain and improving joint alignment, but may not completely correct the deformity 4, 5
• Surgical options can provide significant improvement in IP angle and patient satisfaction, but may require additional procedures to address concomitant deformities 2, 3