From the FDA Drug Label
Naproxen has been shown to be comparable to aspirin and indomethacin in controlling the measures of disease activity, but the frequency and severity of the milder gastrointestinal adverse effects (nausea, dyspepsia, heartburn) and nervous system adverse effects (tinnitus, dizziness, lightheadedness) were less in naproxen-treated patients than in those treated with aspirin or indomethacin. In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease
The best treatment approach for a patient with severe degenerative joint disease (DJD) of the first metatarsal phalangeal joint and ankle, and mild to moderate DJD throughout the remainder of the foot, may include the use of naproxen to reduce joint pain and improve mobility.
- Key benefits of naproxen include:
- Reduction in joint pain or tenderness
- Increase in range of motion
- Improved mobility
- Decrease in morning stiffness
- However, it is essential to weigh the benefits against the potential risks and side effects, such as gastrointestinal adverse effects and nervous system adverse effects 1.
From the Research
The best treatment approach for a patient with severe degenerative joint disease (DJD) of the first metatarsal phalangeal joint and ankle, with mild to moderate DJD elsewhere in the foot, is a multimodal strategy that includes conservative management and potentially surgical intervention, with arthrodesis of the first MTP joint being a valid option for young patients as well, as shown in a recent study 2. This approach should initially focus on conservative management, including:
- Oral NSAIDs such as naproxen (500mg twice daily) or meloxicam (15mg once daily)
- Physical therapy focusing on joint mobilization and strengthening exercises
- Custom orthotic devices to redistribute pressure away from affected joints, particularly with accommodative padding for the first MTP joint and ankle support
- Activity modification to reduce high-impact activities, while maintaining low-impact exercises like swimming or cycling For acute pain flares, local corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) can provide temporary relief, though these should be limited to 3-4 injections per year to prevent tissue damage. If conservative measures fail after 3-6 months, surgical intervention should be considered, with options including arthrodesis (fusion) of the first MTP joint or ankle, or joint replacement depending on the patient's age, activity level, and overall health status, as discussed in various studies 3, 4, 5. It's worth noting that arthrodesis of the first MTP joint has been established as the "gold standard" for the treatment of several first ray disorders, including end-stage hallux rigidus, and can provide pain alleviation and deformity correction, as reported in a study published in the World Journal of Orthopedics 4. Additionally, a study published in the Foot & Ankle Specialist found that cheilectomy can be an effective procedure for stages 1,2, and 3 first MTPJ DJD, with reliable and lasting results 6. However, the most recent and highest quality study 2 suggests that arthrodesis of the first MTP joint can be a valid option for young patients as well, making it a consideration for patients with severe DJD of the first metatarsal phalangeal joint and ankle.