Bunion
Bunion | |
---|---|
Other names | Hallux abducto valgus, hallux valgus NSAIDs, surgery[2] |
Frequency | ~23% of adults[1] |
A bunion, also known as hallux valgus, is a deformity of the
The exact cause is unclear.
Treatment may include proper shoes,
Signs and symptoms
Symptoms may include irritation of the skin around the bunion, and blisters may form more easily at the site. Pain may be worse when walking.
Bunions can lead to difficulties finding properly fitting footwear and may force a person to buy a larger size shoe to accommodate the width of the bunion. If the bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes. It is then considered as being a mechanical function problem of the forefoot.
Cause
The exact cause is unclear.
Excessive pronation of the foot causes increased pressure on the inside of the big toe that can result in a deformation of the medial capsular structures of the joint, subsequently increasing the risk of developing bunions.[7][9]
Pathophysiology
The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its distal (far) end (metatarsus primus varus).
Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small
Diagnosis
Bunion can be diagnosed and analyzed with a
- Mild: 15–20°
- Moderate: 21–39°
- Severe: ≥ 40°
The intermetatarsal angle (IMA) is the angle between the longitudinal axes of the first and second metatarsal bones, and is normally less than 9°.[11] The IM angle can also grade the severity of hallux valgus as:[12]
- Mild: 9–11°
- Moderate: 12–17°
- Severe: ≥ 18°
Treatment
Conservative treatment for bunions include changes in footwear, the use of
Orthotics
Orthotics are splints or regulators while conservative measures include various footwear like toe spacers, valgus splints, and bunion shields. Toe spacers seem to be effective in reducing pain, but there is not evidence that any of these techniques reduces the physical deformity. There are a variety of available orthotics including off-the-shelf commercial products and custom-molded orthotics, which may be prescribed medical devices.[14]
Surgery
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion. For instance, procedures may address some combination of:
- removing the abnormal bony enlargement of the first metatarsal,
- realigning the first metatarsal bone relative to the adjacent metatarsal bone,
- straightening the great toe relative to the first metatarsal and adjacent toes,
- realigning the cartilaginous surfaces of the great toe joint,
- addressing arthritic changes associated with the great toe joint,
- repositioning the sesamoid bonesbeneath the first metatarsal bone,
- shortening, lengthening, raising, or lowering the first metatarsal bone,
- correcting any abnormal bowing or misalignment within the great toe,
- connecting two parallel long bones side by side by syndesmosis procedure
At present there are many different bunion surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure.
Traditional bunion surgery can be performed under local, spinal or general
References
- ^ ISBN 9783319603155.
- ^ a b c d e f g h i j k l m n o p q "Bunions". OrthoInfo - AAOS. February 2016. Retrieved 8 November 2017.
- ^ PMID 26769789.
- ISBN 978-0323081634.
- ^ Dittmar, Jenna; Mitchell, Piers (11 June 2021). "Fashion for pointy shoes unleashed a wave of bunions in medieval England". The Conversation. Retrieved 2021-06-28.
- PMID 34120868.
- ^ ISBN 9780070278998.
- ^ "Bunions (Hallux Abducto Valgus)". Footphysicians.com. 2009-12-18. Archived from the original on 2011-12-08. Retrieved 2011-03-20.
- S2CID 21529142.
- ISBN 9780387383286.
- ^ a b Rebecca Cerrato, Nicholas Cheney. "Hallux Valgus". American Orthopaedic Foot & Ankle Society. Archived from the original on 2016-12-30. Retrieved 2016-12-30. Last reviewed June 2015
- ^ PMID 19442286.
- PMID 24559871.
- PMID 31620619. (see Figure Two for images of orthotics)
External links
- Textbook of Hallux Valgus and Forefoot Surgery, links to complete text in PDF files