A bunion is a ?bump? on the joint at the base of the big toe-the metatarsophalangeal (MTP) joint-that forms when the bone or tissue at the big toe joint moves out of place. The toe is forced to bend toward the others, causing an often painful lump of bone on the foot. Because this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion-from the Latin "bunio," meaning enlargement, can also occur on the outside of the foot pain graph (louisestmary.wordpress.com) along the little toe, where it is called a "bunionette" or "tailor's bunion".
Some people develop bunions from wearing shoes that do not fit correctly (especially high heels or narrow-toed shoes). For other people, bunions are caused by factors beyond their control. These can include a family history of a foot type that is susceptible to bunions, neuromuscular disorders, conditions affecting the joints (e.g., arthritis), severe injury to the foot, deformities at birth, problems that affect the way a person walks (e.g., rolling in at the ankles).
SymptomsPatients with bunions will often display pain over the prominent bump on the inside of their forefoot (the medial eminence?). However, they may also have pain under the ball of the foot (under the area near the base of the second toe). Symptoms can vary in severity from none at all to severe discomfort aggravated by standing and walking. There is no direct correlation between the size of the bunion and the patient?s symptoms. Some patients with severe bunion deformities have minimal symptoms, while patients with mild bunion deformities may have significant symptoms. Symptoms are often exacerbated by restrictive shoe wear, particularly shoes with a narrow toe box or an uncomfortable, stiff, restraining upper.
Physical examination typically reveals a prominence on the inside (medial) aspect of the forefoot. This represents the bony prominence associated with the great toe joint ( the medial aspect of the first metatarsal head). The great toe is deviated to the outside (laterally) and often rotated slightly. This produces uncovering of the joint at the base of the big toe (first metatarsophalangeal joint subluxation). In mild and moderate bunions, this joint may be repositioned back to a neutral position (reduced) on physical examination. With increased deformity or arthritic changes in the first MTP joint, this joint cannot be fully reduced. Patients may also have a callus at the base of their second toe under their second metatarsal head in the sole of the forefoot. Bunions are often associated with a long second toe.
Non Surgical Treatment
Many people with bunions are quite comfortable if they wear wide, well fitting shoes and give them time to adapt to the shape of their feet. A small pad over the bony prominence, which can be bought from a chemist or chiropodist, can take the pressure of the shoe off the bunion. High heels tend to squeeze the foot into the front of the shoe and should be avoided. It is often worthwhile seeing a chiropodist if these simple measures are not quite enough.
If surgery is required to correct a symptomatic bunion, there are several procedures that may be used, depending on the size and degree of the deformity. For mild deformities, a simple shaving of the bony prominence may suffice. At the same time, the tissues on the inner, or medial, side of the joint are tightened to hold the great toe in a more neutral alignment. When only the bone is shaved, this procedure is commonly referred to as a ?Silver? procedure. When the bone is shaved and the soft tissues tightened, this is called a ?modified McBride? procedure.
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