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2015.06.17
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カテゴリ:カテゴリ未分類

Overview

A bunion forms when the bursa (a sac of fluid at friction points between the tendons and bone in some areas and between bone and the skin in others) becomes inflamed along the edge of the joint at the base of the big toe. There are two types of bunions. The acute bunion causes the sharper pain. It develops from a bursitis, a sudden outcropping of a fluid-filled sac. An acute bunion can progress into the second type of bunion, the hallux valgus, a chronic but often painless deformity involving permanent rigidity of the bones. Bunions can form in any part of the foot but occur most often at the big toe joint, where the first metatarsal bone abuts the proximal phalanx of the big toe. Women are more likely than men to get bunions because of the misshapen footwear and elevated heels they wear.

Causes
Bunions have a number of causes, primarily genetics and bad choices in footwear. We inherit traits like flat feet, abnormal bone structure, and loose ligaments and tendons from our parents. When our feet are weakened by these traits and we stuff them into high heels or shoes which don?t support our feet correctly, the repeated stress on the front of the foot may contribute to the formation of a bunion. Other contributing factors are jobs that demand a lot of time standing, obesity, and sudden hormonal changes and weight gain, as in pregnancy. Unfortunately, bunions can lead to many other foot conditions as well. The joint behind the big toe carries much of your body weight and when the bunion makes it sore, you shift your weight onto other areas of the foot. That?s why we frequently see crossover toes, overlapping toes, hammer toes, corns, calluses, and ingrown toenails accompanying bunions. As pain in your foot increases, you?ll also reduce your activity, becoming more sedentary, which has its own quality-of-life issues.
SymptomsWhile bunions may be considered cosmetically undesirable, they are not necessarily painful. In cases where the individual has minor discomfort that can be eased by wearing wider shoes made of soft leather and/or with the aid of spacers-padding placed between the toes to correct alignment-further treatment may not be necessary. (Anti-inflammatory agents can be used to alleviate temporary discomfort at the site of the bursa.) For those who continue to experience pain on a daily basis and who cannot wear most types of shoe comfortably, surgical treatment may be the best choice.

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
Bunions may be treated with proper shoes and corrective inserts such as toe spacers, bunion or toe separators, as well as bunion cushions and splints. In extreme cases, surgery may be needed to remove the bony enlargement of the first metatarsal bone, realigning the bone, or straightening the big toe.


Surgical Treatment
Severe cases may require, along with surgery, cast immobilization and prolonged avoidance of weight-bearing activity. You should know that undergoing surgery for this health problem does not guarantee a cure or even a beneficial health outcome. Bunions, like many other foot conditions, should always be approached from a prevention standpoint, or therapy should be directed at slowing the progression of your deformity.

Prevention
Shop for shoes that possess a removable liner, or insole, and stand on the liner after you have removed it from your shoe. This is an effective method to see if your shoe is wide enough in the forefoot to accommodate your bunion. If your bunion and forefoot are wider than the insole, your shoe will squeeze and constrict your bunion and create the symptoms that define this health problem. The insole should also be wide enough to fully accommodate your big toe when it points outward, away from your other toes.






最終更新日  2015.06.17 21:51:37
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