Bunions What Causes Them

Overview

Bunions Callous

A bunion is a bony deformity of the joint at the base of the big toe. The medical name is hallux valgus. The main sign of a bunion is the big toe pointing towards the other toes on the same foot, which may force the foot bone attached to it (the first metatarsal) to stick outwards. Other symptoms may include a swollen, bony bump on the outside edge of your foot, pain and swelling over your big toe joint that's made worse by pressure from wearing shoes hard, callused and red skin caused by your big toe and second toe overlapping, sore skin over the top of the bunion, changes to the shape of your foot, making it difficult to find shoes that fit. These symptoms can sometimes get worse if the bunion is left untreated, so it's best to see a GP. They'll ask you about your symptoms and examine your foot. In some cases, an X-ray may be recommended to assess the severity of your bunion. Anyone can develop a bunion, but they're more common in women than men. This may be because of the style of footwear that women wear.

Causes

Women are particularly at risk for bunions, as high heels may help aggravate the condition. Bunions may also be caused when bursal sacs, sacs that absorb friction and lubricate the many tendons, bones muscles of the body, in the foot become inflamed or swollen. Bunions may also be prompted by the metatarsal bone, the bone that runs from the heel to the toe of the foot, with one metatarsal bone leading to each toe, of the big toe enlarging or deviating slightly to the outside of the foot.

Symptoms

The symptoms of a bunion include the following development of a firm bump on the outside edge of the foot, at the base of the big toe, redness, swelling, or pain at or near the MTP joint, corns or other irritations caused by the overlap of the first and second toes, restricted or painful motion of the big toe.

Diagnosis

Orthopaedic surgeons diagnose bunions on the basis of physical examination and weight bearing x-rays. Two angles are assessed, the intermetatarsal angle, that is between the first and second metatarsals (the bones that lead up to the base of the toes). If this angle exceeds 9? (the angle found in the healthy foot) it is abnormal and referred to as metatarsus primus varus. the hallux valgus angle, that is, the angle of the big toe as it drifts toward the small toe. An angle that exceeds 15? is considered to be a sign of pathology.

Non Surgical Treatment

Sometimes observation of the bunion is all that's needed. A periodic evaluation and x-ray examination can determine if your bunion deformity is advancing, thereby reducing your chance of irreversible damage to the joint. In many other cases however some type of treatment is needed. Early treatments are aimed at limiting the progression of the deformity and easing the pain of the bunion or an associated joint. Conservative treatments such as orthotics can achieve this but they won't reverse the deformity itself. These options include changes in shoe wear. Foot Mechanics Podiatrists are experts in shoe recommendation. Padding. Pads placed over the area of the bunion can help minimise pain, but will not stop the progression of the bunion. Activity modifications. Avoid activity that causes bunion pain, this could include standing for long periods of time. Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen may help to relieve pain. Icing. Applying an ice pack several times a day helps reduce inflammation and pain. Orthotic devices. Orthotics are the mainstay of non-surgical treatment for bunions.

Bunion Pain

Surgical Treatment

As you explore bunion surgery, be aware that so-called "simple" or "minimal" surgical procedures are often inadequate "quick fixes" that can do more harm than good. And beware of unrealistic claims that surgery can give you a "perfect" foot. The goal of surgery is to relieve as much pain, and correct as much deformity as is realistically possible. It is not meant to be cosmetic. There are several techniques available, often as daycare (no in-patient stay), using ankle block local anaesthetic alone or combined with sedation or full general anaesthesia. Most of the recovery occurs over 6-8 weeks, but full recovery is often longer and can include persistent swelling and stiffness. The surgeon may take one or more of the following steps in order to bring the big toe back to the correct position: (a) shift the soft tissue (ligaments and tendons) around the joint and reset the metatarsal bone (osteotomy), remove the bony bump and other excess bone or (b) remove the joint and connect (fuse) the bones on the two side of the joint (fusion). These are just a few examples of the many different procedures available and your treating surgeon can help you decide the best option for you.

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