| | | |  | | © Reed Group | | |
A bunion is a bony deformity of the foot affecting the joint between the foot and big toe (hallux); it appears as a “bump” on the bone at the base of the big toe. Anatomically it is described as a bony enlargement of the medial eminence at the base of the first metatarsal. Bunions develop over time when the big toe shifts toward the second toe, affecting alignment of the bones and producing the characteristic bump on the metatarsal head at the base of the big toe. Shoe pressure irritates the misaligned portion of the metatarsal head, causing the deformity to enlarge over time. The soft-tissue sac (bursa) between the tendon or muscle and the enlarged bone may become inflamed (bursitis). Arthritis of the big toe joint may also develop, limiting mobility (hallux limitus or hallux rigidus).
Bunions may be asymptomatic or may become painful, swollen, and tender. Although footwear does not cause bunion formation, poorly fitting shoes can exacerbate pre-existing biomechanical instability of the foot. Biomechanical instability has many causes, including trauma and anatomical variations such as “flat foot,” excessive pronation, hypermobility, or a short first metatarsal. Problems with the hips, knees, and ankles can also contribute to bunion formation.
The joint at the base of the fifth metatarsal can also become enlarged (tailor’s bunion), although it is less common.
Risk: The risk of developing bunions increases in genetically predisposed individuals. It is greater in individuals with flat feet, arthritis, and faulty biomechanical foot structure. Foot injuries, congenital deformities, neuromuscular disorders (e.g., cerebral palsy, multiple sclerosis), and occupations that involve extra foot stress from prolonged periods of standing or walking (e.g., waiting tables, factory work, athletics, dancing) may also increase the risk of bunion development. Incidence and Prevalence: Bunions are 2 to 4 times more common in women than in men (Frank). Bunions occur in 3% of the population aged 15 to 30 years, in 9% of the population aged 31 to 60 years, and in 16% of the population older than 60 years (Frank). |
Source: Medical Disability Advisor
| History: Individuals may complain of a painful, bony enlargement on the inside (medial side) of the joint at the base of the big toe. They may report feeling greater pain when shoes are worn. The pain may be intermittent or persistent, mild or severe. Other individuals may report a bony enlargement with no associated pain. Physical exam: Examination of the foot may reveal irritated skin, swelling, and tenderness around the joint at the base of the big toe. The big toe may be pointing toward the second toe or growing over or under the second toe. The individual may experience pain when the bunion is touched or when the joint between the metatarsal bone and the toe is moved. Other signs and symptoms may include thickening of the skin at the base of the big toe, corns and calluses caused by overlapping first and second toes, and restricted motion of the big toe. A thorough examination of the feet, ankles, knees, and hips is important in determining the factors contributing to bunion formation. Those factors will determine the appropriate treatment plan. Tests: Observation is usually all that is needed to identify a bunion. However, weight-bearing x-rays may be ordered to reveal the nature of the bony deformity, extent of joint damage, and angular relationship between the first and second metatarsals (intermetatarsal angle). Weight-bearing x-rays must be taken before any surgery is planned. Blood and urine tests may be performed to rule out other diseases such as rheumatoid arthritis, diabetes, collagen vascular diseases, and gout. |
Source: Medical Disability Advisor
| Nonpainful (asymptomatic) bunions require no treatment. Small and mildly painful bunions are managed by changing the type of footwear to roomier, more comfortable shoes that have a larger toe box (no less than 0.5 cm smaller than the forefoot) (Laughlin). If the joint has sufficient flexibility, padded shoe inserts (orthotics) can be used to correct foot alignment, relieve pressure, and shield the bony enlargement from irritation. The heating effect of ultrasound therapy or whirlpool baths can relieve bunion pain temporarily. The painful bursitis associated with bunions can be treated conservatively with rest, ice, and medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid injections may also be needed to help relieve an inflamed bursa.
Surgery to correct the underlying bone deformity may be indicated for bunions that do not respond to conservative treatment. Surgery is recommended if a bunion causes severe pain or if there is neuritis/nerve entrapment, the great toe overlaps/underlaps the second toe, or ulceration is present. Contraindications to surgery include active infection and extensive peripheral vascular disease.
More than 100 different surgical procedures have been described for bunions, and over a dozen are in common use today. The Silver procedure involves simple removal of the enlarged bump. Osteotomy procedures involve cutting and repositioning the big toe bone (proximal phalanx; Akin procedure), or the first metatarsal bone at the portion closest to the toe (distal portion or metatarsal head; Mitchell, Austin, Hohmann, Wilson procedures), or the portion closest to the midfoot (proximal portion or metatarsal base; Loison-Balascescu, Mau procedures). If arthritis of the metatarsophalangeal joint is present, removal (Keller procedure) or fusion (McKeever procedure) of the joint is often necessary. Most osteotomy procedures require internal fixation and immobilization. |
Source: Medical Disability Advisor
| Symptomatic relief of bunions with conservative treatment is usually effective even when the underlying deformity is not corrected. However, bunions are progressive and do not go away; without treatment, they will become worse with time. Early treatment of a small bunion with corticosteroid injection may relieve the symptoms. Surgery may be necessary for large bunions to achieve relief of symptoms. To prevent a recurrence of symptoms, individuals should wear roomier, more comfortable shoes after recovery. |
Source: Medical Disability Advisor
| Untreated bunions may continue to worsen. Degenerative arthritis may develop in the metatarsophalangeal joint of the big toe, causing pain and stiffness. |
Source: Medical Disability Advisor
| Individuals undergoing conservative treatment who spend a substantial portion of an 8-hour workday standing or walking may need to increase the number of hours of seated work.
If surgery is performed, weight-bearing activity is usually restricted for 2 weeks. Some types of surgery require longer periods of restriction, up to 6 to 8 weeks depending on the type of surgery performed. The individual will need to elevate the foot periodically throughout the day and may have to use a walker, crutches, or wheelchair. Driving is prohibited until normal shoes can be worn. Because the individual will probably be taking prescribed pain medication, drug policies must be reviewed. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual experience symptoms such as a painful bony enlargement on the inside edge of the big toe?
-
Did the physical exam confirm the diagnosis of a bunion?
-
Were x-rays done to determine the nature of the bony deformity, extent of joint damage, and angular relationship between the first and second metatarsals (intermetatarsal angle)?
-
Were additional diagnostic studies done to rule out other conditions such as arthritis or gout?
Regarding treatment:
- Did roomier, more comfortable shoes, placement of taping and toe spacers, or use of orthotics reduce discomfort?
-
Did the condition warrant surgical intervention (severe or worsening deformity, worsening pain)?
-
Would individual benefit from removal (Keller procedure) or fusion (McKeever procedure) of the joint?
Regarding prognosis:
- Based on the treatment required, what was the expected recovery?
-
Was adequate time allotted for recovery? Did individual return to activity too soon?
-
Have follow-up x-rays been taken to rule out complications of the bunion surgery, including infection, osteomyelitis, nonunion, recurrence, and avascular necrosis?
-
Has reflex sympathetic dystrophy been ruled out?
-
Does individual have any underlying conditions such as vascular disease, obesity, or diabetes that may affect recovery and prognosis?
|
Source: Medical Disability Advisor
| "Bunions." FootPhysicians.com. 28 Jul. 2008. American College of Foot and Ankle Surgeons. 2 Dec. 2008 <www.footphysicians.com>.Frank, Crista J., and Dan E. Robinson. "Hallux Valgus." eMedicine. Eds. John S. Early, et al. 10 Sep. 2008. Medscape. 2 Dec. 2008 <http://emedicine.com/orthoped/TOPIC126.HTM>. Laughlin, Richard T., et al. "Bunion." eMedicine. Eds. James K. DeOrio, et al. 30 Mar. 2007. Medscape. 2 Dec. 2008 <http://emedicine.com/orthoped/topic467.htm>. Mayo Clinic Staff. "Bunions." MayoClinic.com. 25 Jan. 2007. Mayo Foundation for Medical Education and Research. 19 May 2005 <http://www.mayoclinic.com/invoke.cfm?id=DS00309>. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|