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How To Detect Bunions

Overview
Bunions Hard Skin
The term ?bunion,? as it is popularly used, describes a variety of deformities involving a painful prominence and swelling at the base of the big toe. Orthopaedists use additional terms to describe the different deformities. The condition in which the big toe deviates from the normal position toward the direction of the second toe is referred to as hallux valgus. Dorsal bunions are a different variety in which the prominence appears on the top of the base of the toe, often the result of an arthritic joint.


Causes
Bunions are among the most common problems of the foot. They are several possible reasons a bunion may develop, though a biomechanical abnormality (improper function of the foot) is the most common cause. In an unstable flat foot, for example, a muscular imbalance often develops that, over time, causes bunions. Bunions tend to run in families, and most podiatrists believe that genetic factors play a role in predisposing some people to develop bunions. Poor shoes, like high heels and pointed toe boxes–exacerbate the condition by speeding up the development of bunions, and by making bunions more painful. Poor shoe choices is at least one of the reasons bunions are much more common in women than men.


Symptoms
Bunions typically start out as a mild bump or outward bending of the big toe. Bunions at this stage are usually only a concern of appearance at this stage, and at this point they often don’t hurt much. Over time, the ligaments that connect the bones of the toe stretch out, and the tendons attaching to the big toe gradually pull it farther and farther towards the second toe. Sometimes patients will find their first and second toes begin to press together too much, and they’ll often get a painful corn between those toes. As the bunion progresses, the big toe may begin to ride on top of the second toe, or vice versa, creating a second deformity. Others will develop bump pain at the site of the bony enlargement on the side of the foot. A painful bursa may develop at that site. This is particularly true in tight shoes. Many patients also develop a painful callus beneath the foot. Capsulitis and other types of metatarsalgia may develop in the joints beneath these calluses, particularly in the second and third metatarsophalangeal joints (the joints in the ball of the foot). Over time, with the toe held in a crooked position for enough time, arthritis develops in the big toe joint. This will usually result in decreased range of motion of that joint (a condition known as “Hallux Limitis”), which as a result, often causes the patient to changes in the way a patient walks. Often the patient walks in an “out-toed”, or duck-like, fashion, which very frequently causes secondary pain in the legs, knee, hip, and low back.


Diagnosis
Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.


Non Surgical Treatment
Technically, you can only ?fix a bunion? with surgery, but many patients don’t need it to get symptom relief. In its early stages, the progression of the bunion deformity can often be dramatically slowed. Removing pressure from the bunion area and balancing the tendon and ligament alignment are the primary goals of mild bunion treatment. For example, it is important to wear shoes that have sufficient room in the toe area to accommodate the bunion - that means softer leather shoes to mold to the deformity and platform type heels for better foot and arch support. Your doctor may also advise the use of pads to protect the bunion from shoe pressure. Customized shoe inserts, called orthotics are made exclusively for your foot and are often used to correct the alignment of the arch and big toe joint. In some cases, physicians also use anti-inflammatory creams around the bunion.
Bunion Pain


Surgical Treatment
Surgery for bunions usually isn’t done unless you have already tried other treatment and it did not relieve your pain. Other treatment includes wearing shoes with lots of room for your toes and using pads and supports in your shoe for protection and comfort. Surgery may be right for you if your toe is too painful, if your bunion is very big, or if you can’t easily do your daily activities. It’s not clear how well bunion surgery works or which kind of surgery is best. How well the surgery works depends on how bad your bunion is, the type of surgery you have, and your surgeon’s experience. Your expectations will play a big role in how you feel about the results of surgery. If you want surgery mainly to improve the way your foot looks, you may be disappointed.


Prevention
The best way to prevent a bunion is to be proactive in the truest sense of the word. Go over your risk factors. If you know that you pronate or have any problem with the mechanics of your foot, talk with a podiatric physician about the correct types of shoes and/or orthoses for you. If you are not sure whether you have such a problem, the podiatric professional can analyze your foot, your stride and the wear pattern of your shoes, and give you an honest evaluation. Has anyone in your family complained of bunions? Does your job involve a lot of standing, walking or other stress on your feet or toes? Do you exercise? If so, what kind of shoes do you wear for sports? For work? For school? Do you ever feel pain in your toes, or have you noticed a pronounced or increased redness on your big toe, or on the other side of your foot, near your little toe? Make sure you let the doctor know. Keep track of whether any relatives have suffered from arthritis or other joint problems, as well as anything else that might be relevant to your podiatric health. If you?ve suffered sports injuries previously, let the doctor know about that, too. In other words, try to give your health care professional the most honest and thorough background you can, so that he or she can make the best evaluation possible.

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