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Posts Tagged ‘Bunions’

What Are The Main Causes Of Hallux Valgus?

2015-06-07

Overview
Bunions Callous
The best thing to say about the natural history of bunions is that they are unpredictable. This is both in terms of whether the bunion deformity will progress, and also whether the bunion will become painful (if it is not already painful). It would probably however be true to say that once a previously painfree bunion has started to become painful it is not common for the bunion to go back to being entirely pain-free.


Causes
Bunions are among the most common problems of the foot. They are several possible reasons a bunion may develop, though a biomechanical abnormality (improper function of the foot) is the most common cause. In an unstable flat foot, for example, a muscular imbalance often develops that, over time, causes bunions. Bunions tend to run in families, and most podiatrists believe that genetic factors play a role in predisposing some people to develop bunions. Poor shoes, like high heels and pointed toe boxes–exacerbate the condition by speeding up the development of bunions, and by making bunions more painful. Poor shoe choices is at least one of the reasons bunions are much more common in women than men.


Symptoms
Redness, swelling, or pain along the inside margin of the foot just behind the great toe. Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting. A painful callus may develop over the bunion. Sometimes a painful corn on the adjacent sides of the first and second toes. Irritation if there is overlapping of the first and second toes. Arthritis may cause stiffness and discomfort in the joint between the great toe and the first metatarsal. There may be a fluid filled cyst or bursa between the skin and the “bunion bone”. Skin over the bunion may break down causing an ulceration, which can become infected.


Diagnosis
Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.


Non Surgical Treatment
Apply a commercial bunion pad around the bony prominence, use only non-medicated pads. Wear shoes with a wide and deep toe box. You should be able to “dimple” the leather over your bunion. Avoid all high heeled shoes. If your bunion becomes painful red, and swollen try elevating your foot and applying ice for about 20 minuets every hour. If symptoms persist, consult your podiatrist or physician.
Bunions Callous


Surgical Treatment
Surgery should only be considered for bunions that are painful, not for correction of the cosmetic appearance! The primary indication for operative intervention should be pain that is not relieved by appropriate non-operative management. Although symptom-free bunions can slowly increase in size over time surgical treatment is not recommended unless significant pain symptoms develop. The prolonged recovery time associated with most bunion operations, combined with the potential for complications means that patients should be extremely cautious of undergoing bunion surgery for purely cosmetic reasons.

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