Even though bunions are a common foot condition, they are probably the one with the most misconceptions. Many people suffer unnecessarily with the pain and/or appearance of bunions for years before seeking treatment out of fear about ?surgery?. The good news is that most bunion pain can be resolved without surgery. Causes
Bunions tend to run in families, although it is the faulty foot mechanics that lead to bunions that are inherited, not the bunions themselves. Some authorities, in fact, suggest that the most significant factor in bunion formation is the poor foot mechanics passed down through families. However, the American Orthopaedic Foot and Ankle Society estimates that women have bunions nine times more often than men, that 88 percent of women in the United States wear shoes that are too small, and that 55 percent of women have bunions. Again, this reflects the wearing of shoes with tight, pointed toes, or with high heels that shift all of your body's weight onto your toes and also jam your toes into your shoes' toe boxes. It should be noted that it generally takes years of continued stress on the toes for bunions to develop. Symptoms
Patients complain of a cosmetically deformed foot, along with some skin changes which occur due to constant irritation. Pain and redness of the joint may also occur. Footwear can be difficult to fit due to the deformity and pain is often exacerbated with physical activity. Some patients may experience pain and difficulty with simple walking. Diagnosis
Clinical findings are usually specific. Acute circumferential intense pain, warmth, swelling, and redness suggest gouty arthritis (see Gout) or infectious arthritis (see Acute Infectious Arthritis), sometimes mandating examination of synovial fluid. If multiple joints are affected, gout or another systemic rheumatic disease should be considered. If clinical diagnosis of osteoarthritic synovitis is equivocal, x-rays are taken. Suggestive findings include joint space narrowing and bony spurs extending from the metatarsal head or sometimes from the base of the proximal phalanx. Periarticular erosions (Martel sign) seen on imaging studies suggest gout. Non Surgical Treatment
Initial treatment of bunions may include wearing comfortable, well-fitting footwear (particularly shoes that conform to the shape of the foot and do not cause pressure areas) or the use of splints and orthotics (special shoe inserts shaped to your feet) to reposition the big toe. For bunions caused by arthritis, medications may help reduce pain and swelling. If nonsurgical treatment fails, your doctor may suggest surgery, which resolves the problem in nearly all persons. The goal of surgery is to relieve pain and correct as much deformity as possible. The surgery is not cosmetic and is not meant to improve the appearance of the foot. Other related procedures that may be used to help diagnose foot disorders include X-rays of the bone and foot. Surgical Treatment
The most simple procedure is reducing the bump, and while there will be a little pain and swelling afterwards and your mobility will be restricted, the recovery time is short (ie a few weeks), but it may not fix the underlying cause. More serious ops might involve lasers, robots, cutting bone in the foot and trying to reposition it, and/or inserting pins or wires. It can take months to recover fully and you might need a cast. Mike O?Neill recommends seeking an NHS consultant surgeon who specialises in bunion removal to ensure the best possible outcome. The type of anaesthetic, local or general, will depend on the procedure, but most are day cases and the surgery will take from less than 30 minutes to a couple of hours. Waiting times vary but from your first outpatient appointment to the op would be a minimum of a few months. Private treatment (preferably by an NHS consultant surgeon) is likely to cost thousands of pounds. A new less, invasive procedure called surgical correction of hallux valgus that makes a small incision in the bone has recently been approved for use in the NHS but there is still no conclusive evidence on how effective it is and it is not widely available. 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.
- 2015/06/12(金) 09:53:18|