title: Intra-articular Hyaluronic Acid Treatment for Golfer's Toe: Keeping Older Golfers on Course.
abstract: Osteoarthritis of the great toe can lead to a progressive decrease in range of motion (ROM) and pain at the first metatarsophalangeal (MTP) joint. This condition, observed in older golfers, results in reduced participation and enjoyment of this popular activity.
  
  
  OBJECTIVE
  To assess the efficacy, safety, and patient satisfaction with a series of intra-articular injections of hyaluronic acid (HA) into the first MTP joint in older patients who reported osteoarthritis-associated pain, loss of MTP joint ROM, and disability that interfered with golf participation.
  
  
  METHODS
  Forty-seven consecutive male golfers met the inclusion criteria and were given a weekly intra-articular HA injection for 8 weeks. Baseline measures of MTP joint ROM, pain at rest and immediately after tiptoe walking for 10 m, and global patient satisfaction (GPS) were compared with measures at 9 and 16 weeks and at presentation for a second injection series.
  
  
  RESULTS
  Adverse events (only local injection site pain was noted) were less than 0.01%. At 9 weeks, significant improvement in pain at rest, pain after tiptoe walking, ROM, and GPS were observed. These changes were maintained for all measures at 16 weeks. At presentation for the second series, GPS was significantly higher than at baseline and at 16 weeks. Pain at rest, tiptoe walking pain, and ROM were significantly improved from baseline, but tiptoe-walking pain was significantly reduced at 16 weeks.
  
  
  CONCLUSIONS
  Intra-articular HA injection significantly improved pain tolerance at rest and with activity. Patient acceptance of the treatment was high, with very few adverse events in golfers who had osteoarthritis of the first MTP joint.
authors.affiliation: Heart Health and Exercise Laboratory, Centre for Activity and Ageing, London, Ontario, N6G 2M3, CAN. petrella@uwo.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Petrella
authors.forename: Anthony
authors.initials: A
authors.lastname: Cogliano