BUNIONS
A bunion is a
structural deformity of the bones and
the joint between the foot and big toe,
and it may be painful.A bunion is an
enlargement of bone or tissue around the
joint at the base of the big toe (metatarsophalangeal
joint).The big toe may turn in toward
the second toe (angulation), and the
tissues surrounding the joint may be
swollen and tender.
Today the
term usually is used to refer to the
pathological bump on the side of the
great toe joint. The bump is the swollen
bursal sac and/or an osseous (bony)
deformity that has grown on the
mesophalangeal joint (where the first
metatarsal bone and hallux meet).
The term "hallux valgus" or
"hallux abducto valgus" are the
most commonly-used medical terms
associated with a bunion
deformity, where "hallux" refers
to the great toe, "valgus"
refers to the abnormal
angulation of the great toe
commonly associated with bunion
deformities, and "abducto"
refers to the abnormal drifting
or inward leaning of the great
toe towards the second toe,
which is also commonly
associated with bunion
disorders. |
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Bunions are caused by a
biomechanical abnormality, where certain
tendons, ligaments, and supportive
structures of the first metatarsal are
no longer functioning correctly. This
biomechanical abnormality may be caused
by a variety of conditions intrinsic to
the structure of the foot--such as flat
feet, excessive ligamentous flexibility,
abnormal bone structure, and certain
neurological conditions. These factors
are often considered genetic. Although
some experts are convinced that poor
fitting footwear is the main cause of
bunion formation,other sources concede
only that footwear exacerbates the
problem caused by the original genetic
deformity.
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 sesamoid bones found
beneath the first metatarsal (which help
the flexor tendon bend the big toe
downwards) may also become deviated over
time as the first metatarsal bone drifts
away from its normal position. Arthritis
of the great toe joint, diminished
and/or altered range of motion, and
discomfort with pressure applied to the
bump or with motion of the joint, may
all accompany bunion development.
Bunions may be treated
conservatively with changes in shoe
gear, different orthotics (accommodative
padding and shielding), rest, ice, and
medications. These sorts of treatments
address symptoms more than they correct
the actual deformity. Surgery, by a
podiatrist may be necessary if
discomfort is severe enough or when
correction of the deformity is desired.
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
cartilagenous surfaces of
the great toe joint,
- addressing arthritic
changes associated with the
great toe joint,
- repositioning the
sesamoid bones beneath the
first metatarsal bone,
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- shortening, lengthening,
raising, or lowering the first
metatarsal bone,
- correcting any abnormal bowing
or misalignment within the great
toe.
The age, health, lifestyle, and
activity level of the patient may also
play a role in the choice of procedure.
Bunion surgery can be performed under
local, spinal, or general anesthetic.
The trend has moved strongly toward
using the less invasive local anesthesia
over the years.
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