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Bunion is a one problem that can develop due to hallux valgus, a deformity of the foot

Posted by : Mr. Sreehari Nair, 19 Nov 2013 03:20 PM
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Dr. Pradeep Moonot, Junior Consultant Orthopaedics at Hinduja Hospital talks about rising number of cases with Bunion in the city


What is a bunion?
Bunion is a problem that can develop due to halluxvalgus, a deformity of the foot.  The Latin meaning of “hallux valgus” is turning outward (valgus) of the first toe (hallux).  The bone that joins the first toe, the first metatarsal, becomes prominent on the inner border of the foot (abunion).  Shoe pressure on this prominence causes inflammation and pain.


Other problems can develop along with hallux valgus.  The metatarsal bones can become prominent in the ball of the foot and the small toe joints can become contracted.  With shoe pressure, corns and calluses can develop.


How many patients do you see per month?
I am surprised because I have been seeing nothing less than 10-20 patients per month and amongst them there are higher percentage of women who have come reporting the problem. More than men it is the women that I seecome ahead to get the deformity reformed.


What is the cause?
There is no single cause of hallux valgus.  It may develop from muscle imbalance as in cerebral palsy or polio.  It may develop from joint destruction as in arthritis. The most common problem is an imbalance of the forces of the toe,present from birth, which causes the hallux valgus to develop progressively with time.



High-heeled, pointed shoes are not the primary cause of the deformity, but they do cause it to be painful. They cause bunions, corns and calluses to develop where there is deformity.


Osteoarthritis, rheumatoid arthritis, infection and gout may all cause pain in the first toe. Therefore, before treatment of a painful bunion can begin, medical evaluation is needed.


Are women more prone to Bunion than men?
Two of the main reason and are interlinked also are flatfoot and wearing narrow shoes. As compared to men, women start wearing sharp toe shoes/sandals from a very tender age. Over the years this also leads to flat foot and this causes the reason to develop bunion. Women report these problems also on a higher note is because this is seen a deformity and not because it is painful.


What is the treatment?
Treatment may be surgical or non-surgical. The goal of thenon-surgical treatment is to relieve pressure on the foot to prevent pressuresores and foot ulcers.  This is accomplished by prescribing accommodative shoes – sandals or extra depth shoes with soft-moulded insoles. 


The goal of surgery is different.  Surgery attempts to realign and balance the first toe to restore normal function. Corns in the small toes may be treated by straightening and shortening the toes.  Arthritis in the first toe can be treated by resurfacing the joint, or removing the joint and fusing the toe straight.  The aim is to produce a foot which fits comfortably into an “off the shelf” shoe but it is not to restore the hallux valgus to a cosmetically normal looking foot.


Complications

Over 90% of patients are very happy with the result of the surgery.  However, as with all procedures, there is always a small risk of complications.


Recognized complications include:

• Infection at the site of the wound.

• Re-occurrence.

•  Over/Under correction.

•  Nerve injury at the time of surgery.

•  Toe joint stiffness.

•  Transfer metatarsalgia.

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