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Hallux valgus is a condition that affects the joint at the base of the big toe. The condition is commonly called a bunion. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal (MTP) joint. In reality, the condition is much more complex than a simple bump on the side of the toe. Interestingly, this condition almost never occurs in cultures that do not wear shoes. Pointed shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus. Wide shoes, with plenty of room for the toes, lessen the chances of developing the deformity and help reduce the irritation on the bunion if you already have one.
Prolonged pressure against the inside portion of the 1st MTP joint can lead to Bunions. This most commonly occurs as a result of wearing pointed toe shoes or shoes that are too tight. Another cause is over-pronation. Normal ?toe-off?occurs from bottom of the big toe. Over-pronation can cause one to ?toe-off? on the inside portion of the big toe versus the bottom. Over time, there is a retrograde force into the joint which pushes it out stretches the joint capsule. This tearing and stretching of the joint capsule as well as the wear and tear on the cartilage is what causes the pain.
SymptomsThe 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.
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
Patients with a painful bunion may benefit from four to six physical therapy treatments. Your therapist can offer ideas of shoes that have a wide toe box (mentioned earlier). The added space in this part of the shoe keeps the metatarsals from getting squeezed inside the shoe. A special pad can also be placed over the bunion. Foot orthotics may be issued to support the arch and hold the big toe in better alignment. These changes to your footwear may allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside. Treatments directed to the painful area help control pain and swelling. Examples include ultrasound, moist heat, and soft-tissue massage. Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. This treatment is especially helpful for patients who can’t tolerate injections.
There is no “standard” bunion, but rather a complex range of joint, bone, muscle, tendon and ligament abnormalities that can cause variation in each bunion’s make-up. As a result, there are a broad variety of surgical techniques for dealing with bunions. Most surgical procedures start with a simple bunionectomy, which involves excision of swollen tissues and removal of the enlarged boney structure. While this may remove the troublesome tissues, however, it may not correct other issues associated with the bunion. The surgeon may also need to tighten or loosen the muscles, tendons and ligaments around the MTP joint. Realign the bone by cutting it and shifting its position (a technique called osteotomy), realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.