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Bunions

Overview
Bunions
A bunion is an enlargement of the joint at the base of the big toe (the metatarsophalangeal or MTP joint) that forms when the bone or tissue moves out of place. The toe bends inward at an awkward angle, which usually creates a large bone lump. If not treated, bunions can become very painful since this area supports a lot of body weight. The MTP joint can also become sore and stiff. Bunions can occur on the outside of the little toe as well.


Causes
You may get bunions if the way your foot is shaped puts too much pressure on your big toe joint. Because bunions can run in families, some experts believe that the inherited shape of the foot makes some people more likely to get them. Your foot rolls inward too much when you walk. A moderate amount of inward roll, or pronation, is normal. But damage and injury can happen with too much pronation. You have flat feet. You often wear shoes that are too tight. All of these may put pressure on the big toe joint. Over time, the constant pressure forces the big toe out of alignment, bending it toward the other toes.


Symptoms
The most common complaint with bunions is pain that develops over the large bump due to shoe pressure. A red, inflamed area can develop, called a bursa. With ongoing pressure, the inflammation can cause throbbing, as it presses against the blood vessels, or swelling in the joint. Shooting pains occur when the swelling presses against the nerve. If left untreated, the constant irritation can lead to arthritis that breaks down the joint, resulting in pain and stiffness.


Diagnosis
People with bunions may be concerned about the changing appearance of their feet, but it is usually the pain caused by the condition that leads them to consult their doctor. The doctor will evaluate any symptoms experienced and examine the affected foot for joint enlargement, tissue swelling and/or tenderness. They will also assess any risk factors for the condition and will ask about family history. An x-ray of the foot is usually recommended so that the alignment of big toe joint can be assessed. This would also allow any other conditions that may be affecting the joint, such as arthritis, to be seen.


Non Surgical Treatment
Follow the advice given by a Podiatrist. Use felt pads to help keep pressure off the painful area of the bunions. Wear shoes that are wide and deep to accomodate the bunions. Fitting of footwear is very important. Avoid the use of high heel shoes. Use exercises to keep the joint mobile. Night splints may help with the bunion symptoms. The aim of these are to hold the toe in a more correct position. Padding or foam between the big toe and the second toe is sometimes recommended, it should, generally, not be recommended as the big toe is usually so strong it just further ’squeezes’ the lesser toes and can lead to problems between these toes. The padding between the two toes will not straighten the big toe. However, sometimes the padding may be needed to help with symptoms that originate inside the joint if the bunion is painful.
Bunions Callous


Surgical Treatment
Depending on the severity of the deformity, this osteotomy can be done either at the end of the metatarsal (a distal osteotomy) or if the deformity is more severe, the osteotomy is performed at the base of the first metatarsal (a proximal osteotomy). One of the more common distal metatarsal osteotomies that is performed is called the chevron osteotomy. Typically a small screw is inserted into the bone to hold the metatarsal head in place and speed up bone healing. Following a chevron osteotomy, walking is permitted in a surgical shoe the next day after surgery and the shoe is worn for approximately three to four weeks before a more comfortable walking/running type shoe is worn.

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