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2015.06.25
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カテゴリ:カテゴリ未分類

Overview

Bunions are bony bumps that form on the side of the big toe joint or baby toe joint (these are commonly called ?bunionettes? or ?tailor?s bunions?). Bunions most commonly result from one or more of the following factors: genetics, faulty foot mechanics like over-pronation, and/or long periods of time spent in improperly fitting footwear. Bunions can start with audible clicking (called ?crepitus?) and/or stiffness in the affected joint which indicates that the joint surfaces are rubbing together improperly. This may progress to include inflammation, degeneration of the surfaces of the joint, deformity (including bone growth at the joint line and displacement of the toe) and ultimately, loss of range of motion in the joint.

Causes
Bunions are most often caused by faulty mechanics of the foot. The deformity runs in families, but it is the foot type that is hereditary, not the bunion.Certain foot types make a person prone to developing a bunion. Injury can be a cause, especially if just one foot is involved. Although wearing shoes that crowd the toes won?t actually cause bunions in the first place, it can make the deformity progressively worse. That means you may expererince symptoms sooner.
SymptomsWith the positional change of the hallux, pain is a common occurrence. As the foot goes through the gait cycle the hallux plays an integral role as the body's weight transmits through during propulsion. With this in mind, it easy to see how the change in the hallux joints (metatarsal phalangeal joint and the proximal interphalangeal) would cause joint narrowing and early degeneration of the articular cartilage. In addition, two small bones (ossicles) found underneath just behind the joint will start placing extra pressure on the metatarsal. Along with bony changes, there are many soft tissue changes as the hallux and metatarsal reposition, which causes added strain to other bony structures and can accelerate the problem.

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
Currently, no strong evidence points to the best treatment for bunions. But in most cases, you can treat them at home. This includes taking medicine you can buy without a prescription to relieve toe pain. It also helps to wear shoes that do not hurt your feet. For example, avoid high heels or narrow shoes. You can wear pads to cushion the bunion, and in some cases, you can use custom-made shoe inserts (orthotics). Avoid activities that put pressure on your big toe and foot. But don't give up exercise because of toe pain. Try activities that don't put a lot of pressure on your foot, such as swimming or bicycling. Surgery to correct a bunion may be an option if other treatment does not relieve pain. There are different types of surgery for bunions. You and your doctor can decide which one is best for you.


Surgical Treatment
Arthrodesis involves fusing together two bones in your big toe joint (metatarsophalangeal joint). The procedure is usually only recommended for people with severe deformities of the big toe joint, which make it too difficult for doctors to completely fix the joint, or when there's advanced degeneration of the joint. After arthrodesis, the movement of your big toe will be severely limited and you won't be able to wear high heels. An excision arthroplasty involves removing the bunion and the toe joint. A false joint is created by scar tissue that forms as a result of the operation. The procedure involves pinning the joint in place with wires, which will be removed around three weeks after surgery is carried out. An excision arthroplasty can only be used in certain circumstances, and is usually reserved for severe, troublesome bunions in elderly people.

Prevention
Shoes that possess tapering toe boxes should be avoided if you have a bunion, as narrow toe boxes will hasten the progression of your bunion deformity. In some cases, conservative measures, including switching to appropriate footwear, may not have the desired effect, and your podiatrist may recommend for you a surgical procedure known as a bunionectomy.






最終更新日  2015.06.25 16:18:07
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