#bunion

Susan had surgery today to correct a bad bunion and a hypermobile ankle. She’s got a nerve block that should last at least til morning but then the word is it will be painful so we’ve stated the pain management drug protocol. I’m thinking she will be ok, she had three kids at home with no drugs.

Here are some interesting takes from Physical Therapy students who studied about foot anatomy, here to inform and to spread awareness of the Hallux Valgus deformity, aka Bunion.

The Hallux Valgus (HV), aka Bunion.

 one of the most common forefoot deformities. 

Women tend to be affected more than men. Trying to keep up with fashion may be a contributing factor if the individual wears tight or pointed shoes, tight stockings, or high-heeled shoes. The cause of hallux valgus is varied. It may result from a hereditary factor and is often familial. 

Occurs in 23% of adults aged 18 to 65 years and up 36% of adults older than 65 years. In adult females, it is as high as 30%. (NLM/National Library of Medicine)

When compared to the barefoot population, the occurrence is higher among individuals who wear shoes or heels. It's interesting to note that in barefoot populations, women are twice as likely to develop HV malformation as males.

Bunion who? A relatively common condition in which the head of the big toe (hallux) point towards the other toes, and the whole phalanx deviates to the opposite side.

"Medial deviation of the head of the first metatarsal bone in relation to the center of the body and lateral deviation of the head in relation to the center of the foot." (Orthopedic Physical Assessment)

There are three changes that happens— callus, thickened bursa, and exostosis—make up the bunion, a condition separate from hallux valgus, although it is the result of hallux valgus

A callus develops over the medial side of the head of the metatarsal bone, and the bursa becomes thickened and inflamed; excessive bone (exostosis) forms, resulting in a bunion. (Orthopedic Physical Assessment)

There are 2 types of bunion:

Congruous Hallux Valgus is a simple exaggeration of the deviation of the big toe. The deformity does not progress, it requires little treatment, and often the biggest problem is cosmetic.

Pathological Hallux Valgus is a potentially progressive deformity. The joint may even go to subluxation. This type may occur in deviated (early) and subluxed (later) stages.

Orthopedic Physical Assessment

Furthermore, HV deformity is more commonly seen in connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, as well as in Down syndrome. (NLM)

It is thought that footwear exacerbates an underlying bony abnormality rather than acting as the primary cause.

Can it be treated?  Yes!! The goal of conservative treatment is to manage the symptoms without correcting the anatomical deformity. This is where Physical Therapists come in. Their treatments include:

 Stretching: Helps maintain joint mobility in the affected joint.

Icing the inflamed deformity to reduce inflammation.

Analgesics: Acetaminophen and NSAIDs.

Medial bunion pads: Prevents irritation of HV deformity. PTs can also recommends: 

Shoe modification: wearing Low-heeled, wide shoes.

Orthoses: Improves alignment and support.

If non-surgical treatments are unable to control the pain, the treatment has failed. If so, surgical management is considered.

Indication for surgery is primarily based on symptoms (difficulty with walking, pain). Interestingly, x-ray appearance does not play a significant role. (National Library of Medicine)

references:

Orthopedic Physical Assessment 6th ed

Shoes that are too tight can cause serious problems. They can lead to bunions, calluses, and Hammertoe. People who wear tight shoes often have to deal with foot pain, and they may even have difficulty walking. In extreme cases, wearing tight shoes can cause permanent damage to the feet.

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