HALLUX VALGUS (Part II)

Even though bunions can be hereditary, most often bunions are related to wearing shoes that are too tight, too narrow and too high causing pressure on the natural anatomy of the forefoot. The joint at the base of the toe flexes with every step and continued pressure on this area causes the joint to continue to enlarge causing increasing pressure, pain, swelling and redness. Warm Epsom salt soaks, bunion pads, bunion night shields, bunion bandages, and even orthotics can provide temporary relief of pain but it is making the decision to wear properly fitting shoes which is the best treatment decision of all.

The angle created between the lines that longitudinally bisect the proximal phalanx and the first metatarsal is known as the hallux valgus angle. Less than 15 degrees is considered normal. Angles of 20 degrees and greater are considered abnormal. An angle >45-50 degrees is considered severe. Hallux valgus is a disruption of the normal alignment of the metatarsophalangeal joint. The hallux abducts while the first metatarsocuneiform segments adduct. The severity of the hallux deformity is measured by (A) hallux valgus angle and (B) intermetatarsal 1-2 angle 4 Long term follow up has shown equally positive outcomes after Chevron osteotomy for both patients both younger and older than 50. Differential Diagnosis

A bunion may cause someone little or even no problem at all, and in such a case there will be no need for treatment to be given. However, it is likely that a bunion will get worse over time, so it is always a good idea to seek medical advice when a bunion starts to develop. While these measures may alleviate the pain, the only way to actually correct a bunion is with surgery. There are different types of procedure available, with the most common method being an osteotomy. This involves a surgeon cutting and removing the bony prominence before realigning the bones.hallux valgus deformity

When you have a bunion, the bump appears swollen, red and painful on the inside of the foot around and in the big toe joint. The bump which you see is essentially the bone protruding towards the inside of the foot. With a bunion, the base of the toe will eventually become bigger and will stick out even more and it might continue to drift toward the rest of the toes and in several cases, the big toe could essentially come to rest under or over the second toe. With no proper treatment, the second toe can put pressure on the third toe changing its proper alignment.

The issue is these sort of shoes possess a lower front end and also a raised back end. This jams your toes into a tight narrow location and squeezes the toes together in an unnatural position. Because the toes get use to their cramped tiny space they’ll adapt themselves to fit in to the restrained area which will ultimately result in the deformity. Genetics can play a significant role at the same time in regards to this health issue. Some individuals possess a predisposition and might wind up with bunions irrespective of what shoes they put on.

A bunionette or Tailor’s Bunion can develop on the joint of the little toe along the outside of the foot. Again the cause of the bunion is the same, most often poor fitting shoes resulting in increased pressure on the forefoot, but in this case the little toe drifts inward towards the big toe. The very best treatment for a bunion is prevention. If that is not possible, then the next best treatment for a bunion is to wear shoes that have a wide toe box allowing ample room for the toes to move around and to avoid getting pressed together causing them to overlap.hallux valgus treatment

How To Prevent Hallux Valgus

Reasons to undergo bunion surgery may include severe foot pain that occurs even when walking or wearing flat, comfortable shoes. Surgery may also be indicated when chronic big toe inflammation and swelling does not subside with rest or medications. Other reasons for surgery include toe deformity, a drifting in of the big toe toward the small toe, and an inability to bend and straighten the big toe. Other complications may include recurrence of the bunion, nerve damage, and continued pain. The surgery may also result in overcorrection of the problem, in which the big toe extends away from the other toes.

Bösch et al 5 first performed this technique in 1984. In a study of 114 patients with long-term follow-up, they demonstrated satisfactory correction of the intermetatarsal and metatarsophalangeal angles with no complications of hallux varus, pseudoarthrosis, or osteonecrosis of the metatarsal head. Magnan et al 7 reported on 118 patients with an average follow-up of 36 months, with good clinical results (91%) and a low recurrence rate (2.5%). The average angular correction obtained was 5° and 7.5° for the intermetatarsal and metatarsophalangeal angle, respectively. 7 Always select well fitting comfortable shoes for wearing and always make sure that your shoes are not irritating or rubbing your pedal skin.

Through an incision (cut), the bunion (part of the bone that sticks out) is removed with a surgical saw or chisel. In some cases this might be enough to correct the deformity. However in more severe cases, extra correction (osteotomy) is needed. A cut is made at the head of the first metatarsal. This allows the bone to be repositioned. Before realignment is complete, tendons that attach to the big toe may need to be cut, or released, to relieve the inward pull on the toe. Normal activities can usually be resumed, after the bones and soft tissue have healed (normally within six to eight weeks). Bunionectomy with Wedge Osteotomyhallux valgus definition

The term hallux valgus denotes deviation of the great toe toward thefibular border of the foot. Hallux valgus is not synonymous with bunion,which is derived from the same root as “bun” or “bunch”,and means an area of swelling. In connection with the foot, bunion usuallyrefers to the prominent medial portion of the first metatarsal head andespecially to the bursa or a bursa plus osteophyte over it, when this exists.A bursa and/or osteophyte may or may not accompany hallux valgus. Same patient as figure above, but now in shoes with 3 inchheels. The intermetatarsal angle has widened in both feet, and a functionalhallux valgus has developed, due to her constricting shoes.

Don’t hold back until your heel spur symptoms get worse before you decide to seek help. Starting your heel pain treatment promptly saves you the anguish of walking with swollen ligaments. You don’t have to put your active lifestyle on hold. read more There are many symptoms of a bunion like swelling, redness or pain at the bottom of the big toe. Initially a bunion could be gifted as non-painful detachment of your big toe towards the others. Because the toe progresses towards the corns, calluses and the malformation of the other toes occur. You will also experience restricted big toe motion.

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