Do Bunions Need Surgical Treatments?


Overview
Bunions
A bunion (hallux abducto valgus) is a bony lump or enlargement that forms in the joint (metatarsal phalangeal joint) at the base of the big toe. The big toe points toward the other toes (lateral deviation) as the bunion progresses. The joint and surrounding tissue becomes inflamed and painful. Occasionally bunions can also form at the joint at the base of the smallest (fifth) toe. They are called a tailor's bunion or bunionette. Bunions can be accompanied by bursitis (inflammation of a small fluid-filled sac adjacent to the joint). With an advanced bunion the big toe may be so deformed that it has to lie over or under the second toe. In this situation it hurts to walk or wear any kind of shoe. About one in three people in most Western countries will get a bunion. They are about ten times more common in women than in men. Older people are more often affected than younger people, although bunions do occur in children with misaligned feet. Bunions should not be confused with gout or arthritis, which can also cause inflammation, deformity and pain around the toes and feet.

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.
SymptomsNo matter what stage your bunion is in, you can be in pain. Though bunions take years to develop, you can experience pain at any stage. Some people don?t have bunion pain at all. Pain from a bunion can be severe enough to keep you from walking comfortably in normal shoes. The skin and deeper tissue around the bunion also may become swollen or inflamed.

Diagnosis
Looking at the problem area on the foot is the best way to discover a bunion. If it has the shape characteristic of a bunion, this is the first hint of a problem. The doctor may also look at the shape of your leg, ankle, and foot while you are standing, and check the range of motion of your toe and joints by asking you to move your toes in different directions A closer examination with weight-bearing X-rays helps your doctor examine the actual bone structure at the joint and see how severe the problem is. A doctor may ask about the types of shoes you wear, sports or activities (e.g., ballet) you participate in, and whether or not you have had a recent injury. This information will help determine your treatment.

Non Surgical Treatment
Detecting and treating bunions can relieve many of the symptoms associated with this condition. Doctors often consider whether the condition requires non-surgical or surgical treatment. The decision is based on the severity of the symptoms. Because bunions often get worse over time, early detection and proper treatment are very important. Some non-surgical methods to reduce the symptoms related to bunions include cushioning the area with padding or tape, taking medication to relieve pain and inflammation, using physiotherapy to reduce pain and related symptoms (e.g., ultrasound, whirlpool baths, joint mobilization), wearing custom orthotics to provide better movement and stability of the foot, wearing well-fitted comfortable shoes that are not too tight (if your shoes used to fit but now are too tight around the bunion area, you may be able to have them stretched in this area), using a special splint at night to decrease the amount the toe angles towards the other toes. When non-surgical methods do not provide relief, surgery may be needed. During surgery, the doctor will remove the tissue or bone in the area of the bunion and attempt to straighten the big toe, and may join the bones of the affected joint.
Bunions

Surgical Treatment
Bunion surgery is occasionally required when the bunion deformity is too advanced for conservative treatment to work. Your surgeon will usually cut an angular section from the bone to correct the alignment. In some cases, multiple toes may need to be straighten.

Prevention
Wear insoles and well-fitting shoes to help slow down the progression of bunions and alleviate discomfort. Cushioning can also help alleviate discomfort. Consider wearing shoes with a wide toe box so they don't crowd your toes. Children can also develop bunions and should wear properly fitting shoes as their feet are still developing.

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