How To Care For Bunions

posted on 31 Mar 2015 02:41 by tracilace
Overview

Bunions

A bunion is a deformity of the metatarsophalangeal (MTP) joint at the base of the big toe. A bunion develops when the first metatarsal bone of the foot turns outward and the big toe points inward (toward the other toes), causing the joint to jut out. A bunion is most likely to develop when susceptible feet are repeatedly squeezed into narrow, pointed-toe footwear. The big toe pushes against the other toes, sometimes diving over or under them. As a result, the base of the big toe ? the metatarsophalangeal (MTP) joint ? juts or angles out from the foot.

Causes

Although they may develop on the fifth (little) toe, bunions usually occur at the base of the big toe. Bunions are often caused by incorrect foot mechanics. The foot may flatten too much, forcing the toe joint to move beyond normal range. In some cases, joint damage caused by arhritis or an injury produces a bunion. And some people are simply born ith extra bone near a toe joint. If you're at risk for developing a bunion, wearing high-heeled or poorly fitting shoes make the problem worse. As new bone grows, the joint enlarges. This stretches the joint's outer covering. Force created by the stretching pushes the big toe toward the smaller ones. Eventually, the inside tendons tighten, pulling the big toe farther out of alignment.

Symptoms

Bunions or hallux valgus tend to give pain predominantly from the metatarsal head on the inner border of the foot. The bunion tends to be painful mainly when in enclosed shoes and so is often more symptomatic in winter. As the front part of the foot splays and the great toe moves across towards the 2nd toe a bunion can also produce pain from the 2nd toe itself. The pain which a bunion produces on the 2nd toe is either due to direct rubbing between the great toe and the 2nd toe, a hammer toe type deformity produced due to crowding of the 2nd toe by the bunion and the 3rd toe.The hammer toe will either be painful from its top aspect where it rubs directly on shoe wear or its under surface in the area of the 2nd metatarsal head. This is made prominent and pushed to the sole of the foot by the 2nd toe rising upwards and driving the metatarsal head downwards.

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

Conservative Treatment. Apply a commercial, nonmedicated bunion pad around the bony prominence. Wear shoes with a wide and deep toe box. If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling. Avoid high-heeled shoes over two inches tall. See your podiatric physician if pain persists. Orthotics. Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity. Padding & Taping. Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain. Medication. Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities. Physical Therapy. Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.

Bunions

Surgical Treatment

For very severe bunion deformities where there is considerable angulation between the first and second metatarsals an osteotomy of the metatarsal may not be sufficient and for these patients, the joint between the first metatarsal and the cuneiform bone is fused with screws, called the Lapidus procedure. This realigns the metatarsal completely and stabilizes the bone, preventing mobility and recurrent deformity.

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.