Do Bunions Require Surgery


Overview
Bunions Hard Skin
The bunion, or hallux valgus, is a condition that affects the bones and joints associated with the great toe. It is one of the most common deformities of the forefoot. The condition develops slowly and results from the gradual dislocation of the joint, usually because of instability during gait. There is a displacement of the first metatarsal bone toward the mid-line of the body, and a simultaneous displacement of the great toe away from the mid-line (and toward the smaller toes). This causes a prominence of bone on the inside (medial) margin of the forefoot, this is termed a bunion. As the deformity progresses, the big toe will shift toward the outside of the foot. In severe cases, the big toe will actually overlap or under lap the second toe. It is often of a hereditary nature, but it is also associated with rheumatoid arthritis and other diseases. There are no exercises, splints or other devices that reliably correct a bunion. Orthotics can sometimes slow or halt the progression by addressing the instability which causes the deformity, but they cannot reduce the deformity.

Causes
Shoes. The primary cause of bunions is the long term use of shoes, particularly tight-fitting shoes with pointed toes, or high heeled shoes. A study that examined people in cultures that do not wear shoes found no cases of bunions. Genetic. People who have misaligned toes or feet, are flatfooted with feet that roll inwards (over pronation), excessive flexibility of ligaments, abnormal bone structure, or have mechanical instability in the big toe joint are more susceptible to bunions. This is especially common when bunions occur in children or young adults. Injuries or other trauma (sprains, fractures or nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease), or limb-length discrepancies (one leg longer than the other). Repetitive stresses to the foot. Bunions are common in ballet dancers and in a few sports. Arthritis.
SymptomsBunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don't hurt much. Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they'll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity. Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis and other types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarsophalangeal joints (the joints in the ball of the foot). Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as "Hallux Limitis"), which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an "out-toed", or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip, and low back.

Diagnosis
Your doctor is very likely to be able to diagnose your bunion simply by examining your foot. Even before that, he or she will probably ask about your family and personal medical history and evaluate the types of shoes you wear. You'll be asked about your symptoms, when they started and when they occur. You may also be asked to flex your toe so that your doctor can get an idea of your range of motion. He or she may order x-rays in order to determine the extent of your deformity.

Non Surgical Treatment
Non-surgical treatments for bunions may include wearing shoes that fit and that have adequate toe room. Stretching shoes professionally to make them larger. Putting bunion pads over the bunion to cushion the pain. Avoiding activities that cause pain, such as being on your feet for long periods of time. Taking over-the-counter pain relievers when necessary, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. Using ice to provide relief from inflammation and pain. Using custom-made orthotic devices.
Bunions

Surgical Treatment
Bunion surgery is most often done on an outpatient or day-surgery basis, usually with a local anesthetic technique called an ankle block. The surgery typically takes an hour or two to perform. Following your surgery, you will stay in the Recovery Room for several hours while the anesthetic wears off. For your safety, you will be required to have someone to drive you home. You should keep in mind that any surgery carries with it very small-but-possible risks of complications such as allergic reaction to anesthesia, bleeding and infection.

What Can Cause Bunions?


Overview
Bunion Pain
A bunion is a firm, fluid-filled pad overlying the inside of the joint at the base of the big toe (metatarsophalangeal joint). The pad (bursa), which may get larger and stick out, can become inflamed and painful. Bunions may run in families, but many result from wearing tight shoes. Nine out of 10 bunions are developed by women. Nine out of 10 women wear shoes that are too small. Tight shoes also can cause other disabling foot problems like corns, calluses and hammertoes.

Causes
The main cause of bunions is excessive pressure being placed on the front of the foot, and is usually the result of wearing high-heeled shoes with pointed toes. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the United States wear shoes that are too small and that 55 percent of them have bunions. Overall, bunions are nine times more common in women than men. In some cases, bunions are hereditary; they also may be caused by arthritis or polio.
SymptomsWith Bunions, a person will have inflammation, swelling, and soreness on the side surface of the big toe. Corns most commonly are tender cone-shaped patches of dry skin on the top or side of the toes. Calluses will appear on high-pressure points of the foot as thick hardened patches of skin.

Diagnosis
Most patients are diagnosed to have bunions from clinical history and examination. However, in some cases, X-rays will be performed to determine the extent of damage to the joint. Furthermore, it will enable the treating doctor to decide on the best course of management of the patient.

Non Surgical Treatment
A bunion may only need to be treated if it's severe and causing significant pain and discomfort. The different treatments for bunions are described below. If possible, non-surgical treatment for bunions will be used, which your GP can discuss with you. Non-surgical treatments can ease the pain and discomfort caused by a bunion, but they can't change the shape of your foot or prevent a bunion from getting worse over time. Non-surgical treatments include painkillers, bunion pads, orthotics, wearing suitable footwear, These are discussed in more detail below. If your bunion is painful, over-the-counter painkillers such as paracetamol or ibuprofen may be recommended.Bunion pads may also ease the pain of a bunion. Reusable bunion pads, made of either gel or fleece, are available over the counter from pharmacies. Some are adhesive and stick over the bunion, while others are held against your foot by a small loop that fits over your big toe. Bunion pads stop your foot rubbing on your shoe and relieve the pressure over the enlarged joint at the base of your big toe. Orthotics are placed inside your shoes to help realign the bones of your foot. They may help relieve the pressure on your bunion, which can ease the pain. However, there's little evidence that orthotics are effective in the long term. It's important that the orthotic fits properly, so you may want to seek advice from your GP or podiatrist (a specialist in diagnosing and treating foot conditions), who can suggest the best ones for you.
Bunions Callous

Surgical Treatment
Larger bunions are commonly treated with the Lapidus Bunionectomy, which involves realigned the displaced bone at its bottom, through a bone mending/fusion procedure. It is with this technique where the the walking advances have been made int he past decade. The Lapidus Bunionectomy has become a popular surgical method since surgeons have become more comfortable with mobilizing their patients post-operatively. Though not all surgeons who perform this procedure have adopted this postoperative protocol.

Prevention
The best protection against developing bunions is to protect and care for your feet every day. Avoid tight and narrow-fitting shoes. Limit your use of high heels. Wear comfortable shoes with adequate space between your longest toe and the end of the shoe. Getting treatment for very flat or very high-arched feet (if you are experiencing symptoms) will give your feet the proper support and help maintain stability and balance.

All The Things You Want To Find Out Regarding Pain In The Foot's Arch


Overview
Like flat feet, high arches may be present from birth, or caused by conditions such as stroke or Charcot-Marie-Tooth disease. Usually, high arches do not cause pain, although you may need custom orthotic cushions made for your shoes. Surgery may become necessary if your high arch foot becomes too painful or leads to arthritis or a stress fracture. Surgery may include reconstructing a ligament, fusing the hindfoot, shifting bones to better alignment, and transferring a tendon from one part of the foot to another.
Arch Pain

Causes
Also known as pes planus, this is when the arch of the foot collapses completely dropping the whole sole of the foot down to the ground. Flat feet are a common cause of foot arch pain. Babies are born with flat feet and as they grow, the foot arches should gradually form, but in approximately 30% of the population, they never do. They can also develop later in life, due to illness, pregnancy, injury, excessive stress on the feet or as part of the aging process. Many people who have flat feet don?t complain of any accompanying symptoms, but some develop foot arch pain, or problems further up the leg such as knee pain or back pain. They may find their feet tire quickly when they are standing or walking, and that it is difficult to rise up onto their tiptoes. Someone who is experiencing pain on the bottom of the foot or elsewhere due to their flat feet can benefit from exercises and orthotics (specially designed insoles to correct the foot position) as well as walking barefoot rather than in shoes. A quick test to see if you have flat feet is to put your foot in a tray of water and then place it on a smooth level surface e.g. thick paper. Have a look at your footprint, the more of the sole of the foot that you can see, the flatter your foot.

Symptoms
People suffering from pain in the arch sometimes complain of burning or soreness on the foot sole, which is worse in the morning and after physical activity. There may also be some tenderness when pressure is applied to the sole of the foot or heel. In addition to this, patients tend to complain of more pain when they stand on tiptoe.

Diagnosis
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch. An area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle.

Non Surgical Treatment
Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain. Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
Foot Arch Pain

Surgical Treatment
Foot surgery is difficult, especially when large amounts of deformity correction are needed. The ability to bring the foot into a new position may not be lasting, even if everything looks perfect in the operating room. The goal is to provide improved position and function of the foot and ankle. In some patients with very severe deformity, the goal is a foot that functions well in a brace. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Particular complications associated with cavus foot surgery include incomplete correction of deformity, return of deformity and incomplete fusion.


Prevention
It is possible to prevent arch pain by wearing well-fitting shoes while performing any physical activity. Many times doctors will suggest a therapeutic shoe with a higher heel to relieve the pressure on the achilles tendon and also the arch muscle (plantar fasciitis). People with arch pain suffer from regular flare-ups of pain. However there is no risk to others as this is not a contagious condition.

Stretching Exercises
Plantar Fasciitis stretches can be incorporated into a comprehensive treatment regime which may involve: ice, heel wedge support, taping, massage, muscle strengthening, orthotic inserts for shoes, topical anti inflammatory gel or oral medication and/or corticosteroid injections. If you suspect you may have Plantar Fasciitis seek accurate diagnosis and treatment from a health professional to ensure a correct diagnosis and reduce the likelihood of developing chronic foot pain. Treatment interventions may be provided by your Physical Therapist, Podiatrist and/or doctor.
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Danyelle Mesiti

Author:Danyelle Mesiti
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