It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn’t stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, they assumed any pain in the great toe accompanied by a bump was a “bunion” or Hallux Abducto Valgus. Unfortunately in this case, her doctor was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. Not what she wanted to hear!
Cavus foot is the term for a condition in which arches are abnormally high. The American College of Foot and Ankle Surgeons explains that due to the high arch, an excessive amount of weight is forced upon the ball and heel of the foot. Consequently, this causes pain when standing or walking and makes the ankle more susceptible to sprains because the foot tends to tilt inward. Cavus foot occurs at any age and happens in one or both feet. A condition referred to as plantar fasciitis also impacts the arch of the foot. This condition is an inflammation of the fibrous ligaments in the arch.
As you can now see, ” hallux valgus ” refers to the outward turning of the bone of the joint of the great toe, or as we say, the big toe, in an abnormal manner. This is the hallux valgus deformity. This outward turning of the bone of the joint, also known as the first metatarsophalangeal joint, is usually combined with soft tissue enlargement under the skin that shows up as a bump on the outside of the foot. This bump is what we call a bunion. In the medical profession today, the term ” hallux valgus ” is used to denote the condition of having a bunion.
There are various bunion correction splints available to help in bunion treatment. You get splints for bunion relief during the day and bunion night splints to help ease pain at night. The basic bunion splint is a simple wrap around the top of the feet and strapped to the toes. This helps holding the big toe in a straight position. Few other splints allow you to melt down the rigid piece in the exact shape that matches the shape of your bunion. You may need shoes that are one size larger when wearing splints during day time.
Another surgical treatment may include fusions of the first metatarsophalangeal joint ( MTP joint ) by arthrodesis and removal of the joint and replace it with a prosthesis ( arthroplasty ) Bunionectomy / exostectomy that involve removal of the medial body prominence of the MTP joint are performed. Osteotomy and realignments can also be performed as well as Lapidus procedure which involves a fusion that is performed at / near the first metatarsophalangeal joint (MTP joint). Manipulation of the soft tissue is also performed to alter the function and structure of the tendons and ligaments.
Hallux varus is not a common deformity. It forms as a result of certain conditions and surgical procedures that disrupt the balance of the big toe. Over-correction of a bunion is the most common cause of hallux varus. It can also occur in children due to congenital deformity, as the result of a tight abductor hallucis tendon pulling the big toe toward the mid-line, and deformity from rheumatoid arthritis or trauma. Displacement or removal of a sesamoid bone, two tiny accessory bones found embedded within the tendon that lies underneath the head of the first metatarsal, can also cause hallux varus. Mild Hallux Varus Deformity
This flexibility exercise is usually performed by a therapist, but can also be performed by the patient himself. Cross your affected foot over your unaffected knee and gently grab your foot with your opposite hand behind the big toe joint. Hold your foot stationary throughout this exercise. Use your other hand to gently begin pulling your bit toe away from your foot as if you were trying to pull your toe directly out of its socket. Hold this pressure and begin to gently rotate your toe in a clockwise/counterclockwise motion. You Might Also Like Dorsiflexion Exercises
Sometimes by merely changing the type of shoes you wear you can prevent the worsening of a bunion. Whether you are a man or a woman, merely changing from a tight, pointed toe shoe to a sandal can help tremendously. So can the wearing of a bunion shoe, available from most orthopedic shoe stores. Both shoe styles remove the source of pressure and have a wider forefront to accommodate a bunion foot. If you do refuse to change shoe styles due to vanity, then your bunion will increasingly become bigger, uglier, and eventually more painful.
OA can affect any of your joints in the feet but most likely to affect the joint at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you roll your foot in excessively as you walk. Wear and tear at the ends of the bone cause the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition called hallux rigidus) which makes walking difficult. Or your big toe may drift towards your other toes ( hallux valgus ) which may cause bunions.
Scheduled appt. With another podiatrist for tomorrow. Called my current Dr. to ask about picking up my x rays that were taken in his office, so I could get a second opinion and also to confirm in writing his instructions from today up until the next 3 weeks. (Walking on my foot without the boot, for an hour a day, increasing it by an additional hr per day, while it still has an unhealed bone in it) He apologized for yesterday’s being short with me. That was very nice of him. He said we would be able to use bone stimulator at 2mo’s post op.