Bilateral Hallux Valgus In Children
OverviewA bunion is a bony lump on the side of your foot, which develops when your big toe starts to angle towards your second toe. The bunion will eventually cause you discomfort and pain. The skin over the lump can become red, blistered or infected. A fluid-filled space called a bursa may also develop under your skin in this area and this can be painful if it becomes inflamed. This is called bursitis. The deformity of your big toe combined with a bunion is sometimes referred to as hallux valgus. CausesAbnormality in foot function, particularly a pronated foot. This is probably the most important and common causative factor. Family history of bunions. Narrow toed dress shoes and high heels may contribute to the formation of a bunion. Rheumatoid and Psoriatic arthritis. Genetic and neuromuscular disease (eg. Down's,Ehler-Danlos and Marfan's syndromes) resulting in muscle imbalance. Limb length inequality can cause a bunion on the longer limb. Generalized laxity of the ligaments. Trauma to or surgery on the soft tissue structures around the great toe (first metatarsal-phalangeal) joint. SymptomsSymptoms, which occur at the site of the bunion, may include pain or soreness, inflammation and redness, a burning sensation, possible numbness. Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions. DiagnosisClinical 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 TreatmentThe most common cause of a bunion is over pronation, this is when your foot rotates in too much as you walk. You really need to treat the underlying cause of the bunion as soon as possible to prevent any further damage. Wear wide fitting shoes, preferably with a leather upper which will allow a stretch. Avoid high heeled shoes. Bunion exercises will help to keep the joint flexible. Bunion surgery may be required in some patients, however this should only be considered when all non-surgical treatment options have been used. Bunion surgery has improved dramatically over the last 20 years but it still cannot guarantee a total recovery and often post operative complications such as calluses and corns can occur depending on the procedure used. If your bunion becomes painful, red and swollen, try using ice on the joint and elevate the foot on a stool. Bunion Night Splints can reduce the size of the bunion. This will straighten the bunion while you sleep. A Bunion Shield can reduce the pain over the bunion. Performing stretches on your toes and feet while you go about your daily routine. This increases circulation, red blood cell activity, and bone realignment. The easiest way to do this is by using a soft, flexible, medical grade gel Toe stretcher which is gentle between the toes and helps to straighten your toes. Surgical TreatmentThe type of surgical procedure performed depends upon the severity of the bunion, the individual?s age, general health, activity level, and the condition of the bones and connective tissue. Other factors may influence the choice of a procedure used. Mild bunion. For this type of surgery, the surgeon may remove the enlarged portion of bone and realign the muscles, tendons, and ligaments surrounding the joint. Moderate bunion. For a moderate bunion, the surgeon may cut the bone and shift it to its proper position. Whether or not the bone is cut depends on the severity and location of the deformity. In addition, the surrounding tendons and ligaments may need to be repositioned. Severe bunion. For a severe bunion, surgery may involve removing the enlarged portion of the bone, cutting and realigning the bone, and correcting the position of the tendons and ligaments. Arthritic bunion or big toe joint. If the joint is damaged beyond repair, as is commonly seen in arthritis, it may need to be reconstructed or replaced with an artificial joint. Joint replacement implants may be used in the reconstruction of the big toe joint.