Lacresha Nastase

29 March 2015

What Are The Symptoms Of Hallux Valgus?

Filed under Non classé — boorishruin3656 @ 13 h 31 min

Overview

Bunion Pain

Hallux abductovalgus (HAV) or bunion, is a commonly seen deformity of the first metatarsophalangeal joint (MPJ) in which the hallux is abducted and everted, frequently overriding the second toe. Although the terms HAV and bunion are often used synonymously (as is done in this paper), it should be noted that a bunion actually refers to the callus and inflamed adventitious bursa overlying the HAV deformity. Even though bunions have been described in the medical literature for several hundred years (the word bunion is believed to be derived from the Latin, bunio, meaning turnip), there continues to be much controversy concerning its etiology. This is most likely because the development of HAV is multifactorial, stemming from a variety of structural and functional aberrancies.

Causes

The underlying cause is a deformity of the joint at the base of the big toe. The deformity is called hallux valgus. In this deformity the joint develops a prominent sideways angle. Due to this deformity the bones of the big toe are pushed towards the smaller toes. The skin over the angled joint then tends to rub on the inside of shoes. This may cause thickening and inflammation of the overlying skin and tissues next to the affected joint. In most cases it is not clear why a hallux valgus deformity develops. There may be some hereditary (genetic) tendency to have a weakness of this joint. In some cases it is associated with a joint problem such as osteoarthritis or rheumatoid arthritis. However, whatever the underlying cause, wearing tight or badly fitting shoes tends to make the problem worse. Wearing such shoes puts extra pressure on the big toe joint and causes friction on the overlying skin.

Symptoms

The most common symptoms associated with this condition are pain on the side of the foot. Shoes will typically aggravate bunions. Stiff leather shoes or shoes with a tapered toe box are the prime offenders. This is why bunion pain is most common in women whose shoes have a pointed toe box. The bunion site will often be slightly swollen and red from the constant rubbing and irritation of a shoe. Occasionally, corns can develop between the 1st and 2nd toe from the pressure the toes rubbing against each other. On rare occasions, the joint itself can be acutely inflamed from the development of a sac of fluid over the bunion called a bursa. This is designed to protect and cushion the bone. However, it can become acutely inflamed, a condition referred to as bursitis.

Diagnosis

X-rays are the best way to determine the amount of deformity of the MTP joint. Blood work may be required to rule out other diseases that may be associated with bunions such as rheumatoid arthritis. Other tests such as bone scans or MRI’s are not usually required.

Non Surgical Treatment

There are many treatment options for bunions and they will vary with the type and severity of each bunion and will also depend on what is causing the symptoms. Bunions are almost always progressive and tend to get larger and more painful with time, how fast this happens may be a function of the fit of the footwear. The initial goal of treatment options is to relieve pressure on the bunion and any symptoms that may be present and to halt or slow the progression of the joint deformity. There is no effective may be “get rid off” a bunion without surgery. There are a number of things that individuals and Podiatrists can do to help the symptoms and slow (if not halt) progression.

Bunions Callous

Surgical Treatment

Surgical treatment for bunion deformities usually involves an osteotomy, a procedure in which a cut or cuts are made in the affected bone or bones to restore proper alignment. Different techniques are used depending on the type of deformity; selection is guided by the degree of deformity present and the goals of preventing recurrence and achieving the most rapid recovery possible. Some of the more common procedures are. The distal chevron osteotomy: a procedure in which a v-shaped cut is made at the toe end of the first metatarsal. This surgery is appropriate for individuals who have a congruent deformity, one in which there is a painful prominence at the base of the toe, but the joint is still well aligned. Absorbable pins are placed in the metatarsal to maintain alignment during healing. The Scarf or Ludloff osteotomy: in this procedure, a more extensive cut is made higher up in the metatarsal to correct a moderate incongruent deformity and metatarsus primus varus. Screws are used to maintain alignment during healing. The crescent osteotomy: a procedure in which a curved cut is made at the base of the metatarsal is appropriate for patients with more severe metatarsus primus varus and, therefore, require more correction. Screws or pins are used to maintain alignment. The Lapidus procedure: individuals who have severe deformity, instability of the first ray, with a loose metatarsal-tarsal joint (located in the mid-foot) may not get enough correction from an osteotomy alone. Moreover, the looseness of the joint may lead to recurrence or be causing pain on the ball of the foot because the first metatarsal is floating up, allowing for excessive weight to go to adjacent metatarsals (commonly the second and the third). In such cases, the metatarsal-tarsus joint is fused to provide lasting stability. Screws are used to maintain alignment. The loss of motion from the fusion is small and does not significantly limit motion of the big toe. Patients undergoing bunion surgery are given an ankle block that anesthetizes the foot from the ankle down. Depending on individual preference, a sedative may be given as well and the patient can be as sedated as they wish. All bunion surgeries may be done on a same-day basis, eliminating the need for hospitalization.

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