FOOT PAIN &
FOOT PAIN CAUSES AND TREATMENT
Bunions and foot pain have been
discussed in the medical podiatry literature for more than 100
years. The term "bunion" is derived from the
Latin word for turnip. Bunions usually occur on both feet
with one foot usually worse than the other. In western
countries, bunions occur more in women due to the type of shoes
women wear. In countries where men and women do not wear shoes,
the incidence of bunions in men and women has been found to be
the same. However, the person's inherited or developed
tendency to walk flat- footed has been shown to be the primary
cause of bunion deformities. In rare circumstances, neurological
disorders, rheumatoid arthritis, and developmental deformities
can also cause a bunion deformity.
Evaluation of a bunion
deformity begins with obtaining a complete history and physical
as well as obtaining X-rays of both feet. Typically, as a bunion
deformity progresses, calluses form under the ball of the foot,
a reddened area appears over the prominent first metatarsal head,
lesser toe deformities appear, shoes no longer fit properly,
degenerative arthritic joint changes occur and the cosmetic appearance
of the foot deteriorates.
Treatment of a bunion
deformity primarily involves two issues, correcting the underlying
cause of the bunion deformity, and when required, surgically
realigning the bunion deformity. In cases where the bunion
deformity is mild to moderate and the patient is not in pain,
custom molded foot orthotics are prescribed to help correct the
weight bearing forces which usually cause the bunion deformity.
realignment of a bunion deformity consists of a realignment of
the great toe and first metatarsal. In some cases where
arthritic joint degeneration has occurred, besides realigning
the joint deformity, the joint must also be fused or artificially
replaced. A bunion deformity actually involves two unique
deformities. The first is the widening of the knuckle joint of
the great toe from the knuckle joint of the second toe and is
called Metatarsus Premus Adductus. Metatarsus Premus Adductus
is measured by measuring the angle created by drawing a bisection
of the first and second metatarsal bones on a weight-bearing
AP X-ray. The angle of the first metatarsal to the second
metatarsal is called the 1-2 Inter-metatarsal Angle and usually
is normal if under 10 degrees. The second deformity is
the rotation of the great toe towards the second toe that is
called the Hallux Abductovalgus Deformity.
In evaluating a patient
for surgical correction of their bunion deformity, ultimately,
the different causes of the patient's Metatarsus Premus Adductus
and Abductovalgus Deformity must be determined by the surgeon.
Usually, the cause of the bunion deformity is solely due
to widening of the first metatarsal away from other metatarsals.
However, there are many anatomical reasons that a bunion
deformity can be in existence and this is why a foot specialist
should evaluate a bunion deformity prior to surgery. In
correcting a bunion deformity, some doctors still cut off a portion
of the knuckle joint of the great toe to narrow the appearance
of the foot but do not realign the knuckle joint of the great
toe. This type of narrowing procedure typically severely
narrows the knuckle joint of the great toe and has been associated
with numerous complications such as early degenerative joint
arthritis. Typically, these narrowing procedures are temporary
in giving any relief to the patient and other surgical procedures
must be performed subsequently to realign the knuckle joint of
the great toe. A second opinion should be obtained from
a foot specialist if a doctor recommends a narrowing procedure
that intends to narrow the knuckle joint of the great toe without
realignment of the joint.
In discussing recovery
expectations, in the hands of a good foot surgeon, for the patient
with a mild to moderate bunion deformity that involves only the
widening of the first metatarsal compared to the second metatarsal,
the patient will have usually a two to four week recovery period
before returning to shoes and can walk on the foot during recovery.
For the patient with a severe bunion deformity that involves
only the widening of the first metatarsal from the second metatarsal,
surgery usually involves an eight to ten week period in which
no weight bearing can occur.
In making a pre-operative
evaluation of the patient, weight bearing X-rays must be evaluated
to determine he appropriate procedures that need to be performed.
The amount of angle between the first and second metatarsal
is one of the main factors in determining which type of procedure
is indicated and how much recovery time will be experienced by
the patient. The angle between the first and second metatarsals
is important because there is a point that the first metatarsal
head can not be sided back gains the second metatarsal. When
the first metatarsal is too wide to slide it over against the
second metatarsal, a wedge procedure must be performed to swing
the metatarsal over far enough to move the first metatarsal head
against the second metatarsal head. In evaluating X-rays, there
are actually 11 other X-ray measurements that are typically evaluated
in deciding what is the correct procedure for correcting a bunion
Early medical intervention
using custom molded functional foot orthotics can in many cases
prevent bunion surgery or slow the progression of the deformity.
The use of foot orthotics after bunion surgery is important in
preventing the return of the bunion deformity. Please review
the foot orthotic article for information on foot orthotics.
There are other interventions that help such as using a silicon
spacer to help align the joint to reduce stress to the ligaments
of the joint.
The best approach in
deciding what to do about a developing buinon is to get an X-ray
early in the progression of the deformity to gain an understanding
of what is the best intervention to either prevent the deformity
from increasing in severity or correcting the deformity before
permanent arthritic changes occur to the joint that can not be
reversed with corrective surgery.
© 1999 PLACENTIA-LINDA FOOT AND ANKLE GROUP PODIATRY ASSOCIATES.
All rights reserved.
1275 North Rose Drive Suite 136, Placentia
51280 Yorba Linda Blvd., Yorba Linda
North Orange County Cities of Yorba Linda (92886, 92887), Anaheim Hills (92807, 92808),
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