Bunion Surgery
- Date: 2007-07-03 - Word Count: 534
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SURGICAL : ORTHOPAEDICS, SUMMER 2001
CHIROPODY REVIEW, JANUARY 2001
A bunion is a painful, and often disabling, prominence at the base of the big toe (hallux), which causes continuous discomfort, especially when walking while wearing shoes.
A bunion, or hallux valgus as it is known medically, is a common condition; it affects women more than men and the incidence increases with age. The causes of the condition are multifactorial. However, the most important factors are genetic (familial). In addition to an inherent tendency for patients to develop bunions, there are a number of risk factors, including:
Inappropriate footwear
Inflammatory problems of the metatarsophalangeal joint
Neurological (nerve) problems
Trauma to the toe itself.
The condition most commonly manifests itself in patients aged 50 or over; however, it also frequently occurs when the patient is a teenager or in their early 20s.
The patient experiences increasing pain and swelling on the inner side of the big toe producing a red, painful, tense swelling. This usually causes pain on walking and can even cause pain at rest.
The anatomy of a bunion
A bunion is caused by an abnormality in the position of the bones in the foot and big toe. Instead of being in line, meeting flatly end-to-end, the bone along the inside of the foot (the first metatarsal) and the first bone of the big toe (hallux) meet at an angle (valgus deformity).
The deformity also means that the ball of the big toe is not positioned properly on two small bones (sesamoid bones) beneath the sole. These sesamoid bones act like two mini-knee caps for the big toe joint and normally allow the flexor tendons to act across its axis.
Over time, the pressure of footwear causes inflammation of the fluid-filled pad (the bursa) which acts to reduce friction over the inner aspect of the joint, and the whole joint swells painfully. In addition the metatarsal bone grows a protrusion (an exostosis), and the tendons in the toe slip from the top and the bottom around to the inside of the metatarsal bone.
How is it cured?
The only way that they can be corrected is by surgery. In the past, surgical operations had meant being off one's feet and in plaster for up to three months. Called osteotomy, this conventional surgery involves cutting out a piece of bone and repositioning the two ends to try and straighten the toe.
Newer treatments are now available which involve the use of specially designed cuts through the bone that supports the great toe, which allow accurate correction of the problem. These new cuts through the bone are associated with the use of modern fixation devices such as specially designed screws or staples. Highly advanced titanium alloy staples, which have been kept in the freezer, are inserted. The alloy has been pre-programmed to return to its original shape when it heats up, and secures the ends of bone together.
These new techniques allow very accurate correction with less pain and a faster rehabilitation. Such surgery can be undertaken as a day case, patients then spend 10-14 days in splints and then four weeks in trainers. After this, patients can move into any appropriate footwear they desire.
This surgery is carried out a number of hospitals including the Devonshire Hospital's foot and ankle unit in London.
CHIROPODY REVIEW, JANUARY 2001
A bunion is a painful, and often disabling, prominence at the base of the big toe (hallux), which causes continuous discomfort, especially when walking while wearing shoes.
A bunion, or hallux valgus as it is known medically, is a common condition; it affects women more than men and the incidence increases with age. The causes of the condition are multifactorial. However, the most important factors are genetic (familial). In addition to an inherent tendency for patients to develop bunions, there are a number of risk factors, including:
Inappropriate footwear
Inflammatory problems of the metatarsophalangeal joint
Neurological (nerve) problems
Trauma to the toe itself.
The condition most commonly manifests itself in patients aged 50 or over; however, it also frequently occurs when the patient is a teenager or in their early 20s.
The patient experiences increasing pain and swelling on the inner side of the big toe producing a red, painful, tense swelling. This usually causes pain on walking and can even cause pain at rest.
The anatomy of a bunion
A bunion is caused by an abnormality in the position of the bones in the foot and big toe. Instead of being in line, meeting flatly end-to-end, the bone along the inside of the foot (the first metatarsal) and the first bone of the big toe (hallux) meet at an angle (valgus deformity).
The deformity also means that the ball of the big toe is not positioned properly on two small bones (sesamoid bones) beneath the sole. These sesamoid bones act like two mini-knee caps for the big toe joint and normally allow the flexor tendons to act across its axis.
Over time, the pressure of footwear causes inflammation of the fluid-filled pad (the bursa) which acts to reduce friction over the inner aspect of the joint, and the whole joint swells painfully. In addition the metatarsal bone grows a protrusion (an exostosis), and the tendons in the toe slip from the top and the bottom around to the inside of the metatarsal bone.
How is it cured?
The only way that they can be corrected is by surgery. In the past, surgical operations had meant being off one's feet and in plaster for up to three months. Called osteotomy, this conventional surgery involves cutting out a piece of bone and repositioning the two ends to try and straighten the toe.
Newer treatments are now available which involve the use of specially designed cuts through the bone that supports the great toe, which allow accurate correction of the problem. These new cuts through the bone are associated with the use of modern fixation devices such as specially designed screws or staples. Highly advanced titanium alloy staples, which have been kept in the freezer, are inserted. The alloy has been pre-programmed to return to its original shape when it heats up, and secures the ends of bone together.
These new techniques allow very accurate correction with less pain and a faster rehabilitation. Such surgery can be undertaken as a day case, patients then spend 10-14 days in splints and then four weeks in trainers. After this, patients can move into any appropriate footwear they desire.
This surgery is carried out a number of hospitals including the Devonshire Hospital's foot and ankle unit in London.
Related Tags: pain, foot, surgeon, simon, swelling, moyes, orthopaedic, bunion
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