Bunion
From Wikipedia, the free encyclopedia
| ICD-10 | M20.1 |
|---|---|
| ICD-9 | 727.1 |
| DiseasesDB | 5604 |
| eMedicine | orthoped/467 |
A bunion (hallux valgus) is a sometimes painful structural deformity of the bones and the joint between the foot and big toe.
The term "bunion" originally referred to an inflamed and painful bursal sac on the side of the great toe joint. A bunion is an enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint). If you have a bunion, you will notice a bump on your big toe joint. The big toe may turn in toward the second toe (displacement), and the tissues surrounding the joint may be swollen and tender.[1]
Today the term usually is used to refer to the pathological bump on the side of the great toe joint. The bump is the swollen bursal sac and/or a osseous (bony) deformity that has grown on the mesophalangeal joint (where the first metatarsal bone and hallux meet).
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[edit] Medical terms
The term "hallux valgus" or "hallux abducto valgus" are the most commonly-used medical terms associated with a bunion deformity, where "hallux" refers to the great toe, "valgus" refers to the abnormal rotation of the great toe commonly associated with bunion deformities, and "abducto" refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunion disorders.
[edit] Bunion formation/development
Bunions develop via long-term warping caused by pointed shoes during the growth phase of the foot causing this joint at the base of the big toe to thicken and enlarge. This causes the bones of the big toe to angle in toward the second toe, and leads to an often painful lump of bone which forms at the outside-edge base of the big toe.
Bunions are not only associated with an enlarged bony bump at the big toe joint. Bunions are commonly associated with a deviated position of the big toe where it leans in towards the second toe; and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (they help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position.
Arthritis of the great toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development.
[edit] Symptoms
The symptoms of bunions include:[2]
- Swelling or enlargement of the metatarsophalangeal joint at the base of the big toe.
- Displacement of the big toe toward the other toes.
- Joint redness.
- Joint pain.
- Skin irritation over the bunion.
[edit] Causes
The abnormalities associated with bunion development are caused by a biomechanical abnormality, where certain tendons, ligaments, and supportive structures of the first metatarsal are no longer functioning correctly. This biomechanical abnormality may be caused by a variety of conditions intrinsic to the structure of the foot--such as flat feet, excessive ligamentous flexibility, abnormal bone structure, and certain neurological conditions. These factors are commonly genetic.
Bunions can also be induced by an extrinsic cause, such as inappropriate shoe gear. In fact, bunions are more common in shoe-wearing societies.[citation needed] High heels and tight toe boxes are particularly problematic, which is one reason why bunions are more common in women than in men.[citation needed] Inappropriate shoes can also exacerbate symptoms associated with bunions, regardless of the original cause.
[edit] Treatment
Bunions may be treated conservatively with changes in shoe gear, different orthotics (accommodative padding and shielding), rest, ice, and medications. These sorts of treatments address symptoms more than they correct the actual deformity. Surgery may be indicated if discomfort is severe enough, or when correction of the deformity is desired.
[edit] Surgery
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion deformity. For instance, procedures may address some combination of:
- removing the abnormal bony enlargement of the first metatarsal,
- realigning the first metatarsal bone relative to the adjacent metatarsal bone,
- straightening the great toe relative to the first metatarsal and adjacent toes,
- realigning the cartilagenous surfaces of the great toe joint,
- addressing arthritic changes associated with the great toe joint,
- repositioning the sesamoid bones beneath the first metatarsal bone,
- shortening, lengthening, raising, or lowering the first metatarsal bone, and
- correcting any abnormal bowing or misalignment within the great toe.
The age, health, lifestyle, and activity level of the patient may also play a role in the choice of procedure.
Bunion surgery can be performed under local, spinal, or general anesthetic. The trend has moved strongly towards using the less invasive local anesthesia over the years. A patient can expect a 6- to 8-week recovery period during which crutches are usually required for aid in mobility. It is much less common today as newer, more stable procedures and better forms of fixation (stabilizing the bone with screws and other hardware) are used.
Most bunions are managed without surgery, and foot specialists emphasize that prevention is always best. To minimize the chance of developing a bunion, choose shoes that have square/wide toe areas. Shoes, which are short, tight, or sharply pointed should be avoided. No other primate suffers from bunions as homo sapiens are the only species that wear shoes.
As well, avoid high-heeled shoes, because they are a major contributor to the development of bunions. If you are developing a bunion, wear shoes that are roomy enough not to put pressure on it, which should help with a large amount of the pain associated with a bunion. Shoes can be stretched professionally. Protective padding to cushion the bunion area (such as a non-medicated bunion pad which fits around the bony lump) should be worn with shoes. If bunions are left untreated, they can lead to the risk of serious infection in some patients (such as people with diabetes).
[edit] Orthotics: bunion cushions, splints, regulators
Other measures include various footwear like gelled toe spacers, bunion / toes separators, bunion regulators, bunion splints, and bunion cushions[3][4]
[edit] References
- ^ Topic overview. Bunions. WebMD (March 26, 2004). Retrieved on 2006-10-15.
- ^ Symptoms. Bunions. WebMD (March 26, 2004). Retrieved on 2006-10-15.
- ^ Bunions/Toes. Foot Smart. Retrieved on 2006-10-15. List of products for treatment and relief of bunions.
- ^ Bunion Relief. Pedifix. Retrieved on 2006-10-15. Another list of bunion relief products.
[edit] External links
- Crista J. Frank, Dan E. Robinson (March 16, 2005). Hallux vulgaris. eMedicine. WebMD. Retrieved on 2006-10-15.
- Footwear and healthy feet
