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Dealing With A Bunion

Overview
Bunion Pain
Though a bunion is often described as a painful bump, this condition is much more complex than a simple bump on the side of the toe. X-rays show the true nature of the deformity and are used to help in the decision making process. Ranges of motion of joints associated with the toe are also performed to assess the deformity. There are many procedures for correcting a bunion and choosing the right one based on the examination increases the chance of success. The procedure performed on one person may not be the procedure required to give another a good result. In general, more severe bunion deformities require more extensive surgery and more extensive post-operative limitations. It is very important to note that the same instability and incorrect motion that causes a bunion also causes degeneration of the joint surfaces (osteoarthritis). Correction of the bunion cannot repair the damage done within the joint and continued pain from that separate process may occur. Realigning the joint may slow the damage within the joint and improve motion, but it may not alleviate all pain.


Causes
Shoes. The primary cause of bunions is the long term use of shoes, particularly tight-fitting shoes with pointed toes, or high heeled shoes. A study that examined people in cultures that do not wear shoes found no cases of bunions. Genetic. People who have misaligned toes or feet, are flatfooted with feet that roll inwards (over pronation), excessive flexibility of ligaments, abnormal bone structure, or have mechanical instability in the big toe joint are more susceptible to bunions. This is especially common when bunions occur in children or young adults. Injuries or other trauma (sprains, fractures or nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease), or limb-length discrepancies (one leg longer than the other). Repetitive stresses to the foot. Bunions are common in ballet dancers and in a few sports. Arthritis.


Symptoms
Signs and symptoms of a bunion include the base of the big toe is swollen and sticks out. The big toe is often bent towards the other toes, and sometimes the second toe is pushed to overlap the third toe. Skin around the big toe joint is red and sore. Thickened skin at the base of the big toe. Pain in the big toe or foot. Wearing shoes is painful. Pain or difficulty when walking.


Diagnosis
When an x-ray of a bunion is taken, there is usually angulation between the first metatarsal bone and the bones of the big toe. There may also be angulation between the first and second metatarsal bones. These angular irregularities are the essence of most bunions. In general, surgery for bunions aims to correct such angular deformities.


Non Surgical Treatment
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling. If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot. Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot.
Bunions


Surgical Treatment
Orthopaedic surgeons use many different surgical procedures to treat bunions. The common goal of these procedures is to realign the joint, relieve pain, and correct deformity. These procedures include repair of the Tendons and Ligaments Around the Big Toe. These tissues may be too tight on one side and too loose on the other, creating an imbalance that causes the big toe to drift toward the others. Often combined with an osteotomy, this procedure shortens the loose tissues and lengthens the tight ones. Removal of the damaged joint surfaces, followed by the insertion of screws, wires, or plates to hold the surfaces together until it heals. Used for patients with severe bunions, severe arthritis, and when other procedures have failed. Removal of the bump on the toe joint, used only for an enlargement of the bone with no drifting of the big toe. This procedure is seldom used because it rarely corrects the cause of the bunion. Removal of the damaged portion of the joint, used mainly for patients who are older, have had previous bunion surgery, or have severe arthritis. This creates a flexible “scar” joint. The surgical cutting and realignment of the joint. Your orthopaedic surgeon will choose the procedure best suited to your condition.

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