Dealing With Bunions

posted on 05 Jun 2015 20:11 by oceanicbirthmar4
Overview
Bunion Pain Bunion deformities are often part of a more generalized problem related to improper foot motion as you walk. The name for this is "pronation". Wearing orthotics can slow the progress of a bunion deformity. There are presently over 25 types of bunion procedures performed today. The choice of procedure is based on many factors including age, medical history, physical exam, and x-ray evaluation.

Causes
Improper footwear. Podiatric physicians have long believed that narrow, poor-fitting shoes with a tight toe box tend to compress the end of the foot, leading to abnormal motion of the foot and pressure over the MTP joint. High-heeled shoes tend to add even more pressure to the toes, as the foot slides downward. Over time, continued pressure will squeeze the toes together, encouraging the deformity. Occupational hazards. Individuals whose jobs place undue stress on their feet are among those who complain of bunions. Ballet dancers, in particular, put great demands on their toes, and thus are often subject to bunions, however, they are not alone. Many professionals whose jobs require a great deal of standing or walking (teachers, police officers, doctors and nurses, etc.) and/or who are required to wear a particular type of shoe or boot as part of a uniform, also are at risk. Athletes such as runners or walkers, who utilize the wrong footwear, may also develop bunions.

Symptoms
Patients complain of a cosmetically deformed foot, along with some skin changes which occur due to constant irritation. Pain and redness of the joint may also occur. Footwear can be difficult to fit due to the deformity and pain is often exacerbated with physical activity. Some patients may experience pain and difficulty with simple walking.

Diagnosis
X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI's are not usually required.

Non Surgical Treatment
Bunions can be treated conservatively (without surgery) using simple measures such as well-fitting shoes, orthoses simple painkillers and padding. Physiotherapy can help improve associated muscle imbalances. Such measures will not correct or even stop the deformity but they can help with symptoms. When non-surgical treatments prove insufficient, surgery can relieve your pain, correct any related foot deformity and help you resume your normal activities. Bunions

Surgical Treatment
When a surgeon cuts and repositions a bone, it is referred to as an osteotomy. There are two basic techniques used to perform an osteotomy to realign the first metatarsal. In some cases, the far end of the bone is cut and moved laterally (called a distal osteotomy). This effectively reduces the angle between the first and second metatarsal bones. This type of procedure usually requires one or two small incisions in the foot. Once the surgeon is satisfied with the position of the bones, the osteotomy is held in the desired position with one, or several, metal pins. Once the bone heals, the pin is removed. The metal pins are usually removed between three and six weeks following surgery. In other situations, the first metatarsal is cut at the near end of the bone (called a proximal osteotomy). This type of procedure usually requires two or three small incisions in the foot. Once the skin is opened the surgeon performs the osteotomy. The bone is then realigned and held in place with metal pins until it heals. Again, this reduces the angle between the first and second metatarsal bones. Realignment of the big toe is then done by releasing the tight structures on the lateral, or outer, side of the first MTP joint. This includes the tight joint capsule and the tendon of the adductor hallucis muscle. This muscle tends to pull the big toe inward. By releasing the tendon, the toe is no longer pulled out of alignment. The toe is realigned and the joint capsule on the side of the big toe closest to the other toe is tightened to keep the toe straight, or balanced. Once the surgeon is satisfied that the toe is straight and well balanced, the skin incisions are closed with small stitches. A bulky bandage is applied to the foot before you are returned to the recovery room.

Prevention
The best way to reduce your chances of developing bunions is to wear shoes that fit properly. Shoes that are too tight or have high heels can force your toes together. Bunions are rare in populations that don?t wear shoes. Make sure your shoes are the correct size and that there's enough room to move your toes freely. It's best to avoid wearing shoes with high heels or pointy toes.
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