How To Handle Bunions

Overview
Bunions Callous
Bunions are probably the most common foot disorder seen in podiatry. The term bunion itself is used by patients describing the bony lump found near the base of the big toe, which is usually an adaptation of the positional change of the big toe. Hallux abducto valgus (HAV) is a medical term, which describes the position of the hallux (big toe) with respect to the connecting bone of the mid foot (metatarsal). In this foot disorder, the hallux deviates towards the lesser toes and the metatarsal moves towards the midline.

Causes
People born with abnormal bones (congenital) in their feet. Inherited foot type. Foot injuries. Inflammatory or degenerative arthritis causing the protective cartilage that covers your big toe joint to deteriorate. Wearing high heels forces your toes into the front of your shoes, often crowding your toes. Wearing shoes that are too tight, too narrow or too pointed are more susceptible to bunions. Pain from arthritis may change the way you walk, making you more susceptible to bunions. Occupation that puts extra stress on your feet or job that requires you to wear ill-fitting shoes. The tendency to develop bunions may be present because of an inherited structural foot defect.
SymptomsThe main sign of a bunion is the big toe pointing towards the other toes on the same foot, which may force the foot bone attached to it (the first metatarsal) to stick outwards. Other symptoms may include a swollen, bony bump on the outside edge of your foot, pain and swelling over your big toe joint that’s made worse by pressure from wearing shoes, hard, callused and red skin caused by your big toe and second toe overlapping, sore skin over the top of the bunion, changes to the shape of your foot, making it difficult to find shoes that fit. These symptoms can sometimes get worse if the bunion is left untreated, so it’s best to see a GP. They’ll ask you about your symptoms and examine your foot. In some cases, an X-ray may be recommended to assess the severity of your bunion. Anyone can develop a bunion, but they’re more common in women than men. This may be because of the style of footwear that women wear.

Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.

Non Surgical Treatment
Pain is the main reason that you seek treatment for bunion. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to off-load the bunion. As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal toe and foot joint range of motion and muscle length. Treatment may include joint mobilisation and alignment techniques, massage, muscle and joint stretches, taping, a bunion splint or orthotic. Your physiotherapist is an expert in the techniques that will work best for you. Your foot posture muscles are vital to correct the biomechanics that causing your bunion to deteriorate. Your physiotherapist will assess your foot posture muscles and prescribe the best exercises for you specific to your needs. During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals. Bunions will deform further with no attention. Plus, the bunion pain associated does have a tendency to return. The main reason is biomechanical. In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend either a temporary off-the shelf orthotic or refer you to a podiatrist for custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes. Your physiotherapist will guide you.
Bunions

Surgical Treatment
Bunionectomy is a general term that describes a variety of bone and soft tissue procedures that are intended to realign your big toe and reduce the prominence at the base of your big toe. The procedures chosen are based on numerous factors, including measured angular displacement of your involved joints (especially your first MTP joint). The degree of pain you are experiencing. The degree of joint dislocation and cartilage damage within your affected joint. Flexibility of your adjacent joints. Flexibility of soft tissues in your problem area.

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