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Conditions 1 thru 5 shown of 5 total Conditions available in the Knowledge Base related to bunion.

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Bunion

Description:

bunionThe term bunion refers to a bump of bone that becomes prominent at the great toe joint. A bunion is actually normal anatomy that has shifted to a position where the bump becomes more noticeable and prominent. Bunions become more common as we age but are not uncommon in teenagers and young adults. Bunions are found more often in women than in men. Not all bunions are painful. When painful, bunion pain is caused by two factors. The first is direct pressure from shoes on the bunion. And the second source of pain is due to arthritis that develops within the great toe joint. Bunions are also called HAV, hallux valgus or hallux abducto valgus.

bunionDo high heels contribute to the onset of bunions? The degree to which shoes contribute to the onset of a bunion is questionable. There's no hard science to say that any particular type of shoe contributes to the formation of a bunion. We can say with certainty that bunions are an inherited disorder. More specifically, we don't actually inherit a bunion, but we inherit a set of bones, joints and ligaments in our feet and lower extremity that are very similar to that which we would see in our parent's and our grandparent's feet. The same biomechanical events that took place to cause the parent's bunion problems are recreated with each step in each new generation.

Why does a bunion hurt? Bunions increase the width of the forefoot. As the forefoot becomes wider, it becomes increasingly more difficult to fit into a shoe. Bunions also change the position of the joint and force the great toe joint to function in a manner that promotes arthritis of the great toe joint. As the arthritis becomes increasingly evident, the great toe will ache both with and without shoes.

Bunions become more common as we age. Bunions aren't really a product of old age, but rather a combination of genetic factors that given enough time will develop into a bunion. Bunions are not uncommon in teenagers and young adult. There are some very specific biomechanical characteristics that contribute to the early development of bunions in children. These characteristics are somewhat technical but your doctor should take these into account before prescribing treatment such as surgery. Surgical procedures for pediatric bunions tend to be somewhat more aggressive in nature merely due to the fact that the child has a lifetime in which the bunion may recur.

Treatment of Bunions

Should you have your bunion corrected? Has your foot pain affected your job? Has your pain limited the kinds of shoes you like to wear? There's a number of different factors that ultimately affect a patient's decision to have their bunion corrected, but the single most important issue is pain.

Surgery is the only way to correct a bunion. In poor surgical candidates, bunion pads are helpful to relieve shoe pressure. We always recommend patients try wider shoes with softer shoe materials such as leather. A good leather shoe can be stretched to accommodate a bunion. Clogs are also a remarkably good solution for patients with bunions. Clogs offer a wide toe box that can accommodate bunions and hammer toes.

Bunion surgery has a long and colorful history. There's probably more than 400 different combinations of procedures that are named after this doctor or that doctor. Most doctors use just a handful of these procedures. Surgeons are no different than anyone else. Once a surgeon finds a technique that works they have a tendency to stick with it.

Foot surgeons classify bunions based upon three criteria; (1) Size of the bump (medial eminence) (2) abduction of the great toe and (3) the inter-metatarsal angle. Each of these issues become a part of the treatment plan and guide your doctor to determine which procedure would be best for you.

bunion_x-ray_pre-op_and_post-opWhen planning bunion surgery, foot surgeons use x-rays as a blueprint to evaluate surgical choices. The age of the patient is an issue to be considered when planning a bunion surgery. We are much more aggressive with younger patients and less so with older patients. The younger the bunion patient, the more chance that patient has for the bunion to recur during their lifetime. So subsequently, additional considerations must be made when planning for bunion surgery in children. Other pre-operative considerations include the patient's occupation and the patient's overall health status.

A bunion procedure is normally performed on an out-patient basis. Most bunionectomies are performed under local anesthesia with IV sedation at a surgery center or hospital. This is the preferred setting because it's the safest and most comfortable setting for patients. Patients are given a sedative through their IV that makes them very sleepy while their foot is anesthetized prior to the procedure. In the hands of a skilled anesthesiologist, most patients remember very little of their procedure and are ready to return home in just a short time after their procedure is completed.

Most surgeons use a long acting anesthetic in surgery that will keep the foot numb for up to 8 hours. This allows patients to get home and situated comfortably. The two most important tools used post-operatively to control pain are ice and elevation. Foot surgery is unique in the fact that we're going to be walking on an area of the body that recently underwent surgery. Obviously that presents with some challenges. When the foot is placed down below the level of the heart it's going to swell. When it swells it is going to hurt, particularly during the first few days following surgery. Patients who plan ahead and spend time with their foot elevated use very little pain medication following surgery. Ice is a must. Ice will help to reduce swelling thereby controlling any pain without the use of narcotics.

Recovery time following a bunionectomy will vary with the choice of procedure, the patient's occupation and general health status. Most post-op patients can bear weight immediately following surgery for short periods of time. Patients will be limited for several days in walking and will return to about 50% of their normal activities at 3 weeks. Most post-op bunion patients will return to regular shoes at about 5-6 weeks post surgery.

Postoperatively, many doctors use a removable walking cast called a cam walker to protect the surgical site during healing. Additional post-op care may include a forefoot compression sleeve to control swelling or a bunion regulator to wear while sleeping.

Another important consideration in any surgery is family, friends, bosses and co-workers. Bunionectomy patients need to establish a few designated support people before they have their surgery. Widows, widowers and single parents are special cases and need to be sure they have enough support at home for meals, laundry etc. And lastly, bosses and co-workers are counting on realistic expectations of when you return to work and when you do, are you going to limited in any way? If so, how long? It's pretty easy to see that the technical component of completing a bunionectomy is just one part of a successful outcome.

Can a bunion return after being surgically corrected? Occasionally. As a rough estimate (non-scientific), many doctors will estimate the percentage of chance of recurrence of a bunion to be 60 minus your age. So for a 50 year old patient, the percentage of chance that a bunion would reoccur would be about 10%. hallux_varus

Post operative complications can occur but are uncommon with bunionectomies. With any surgery you need to consider the possibility of infection, delay in healing or scar formation. These are problems that can occur in any surgery, even to the best of surgeons using the latest techniques. One complication specific to bunionectomies is overcorrection of the bunion resulting in hallux varus. Hallux varus is uncommon and is usually associated with removal of the fibular sesamoid in a Modified McBride procedure.


 

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Turf Toe

Description:

Turf_toe_x-rayTurf toe is the term used in athletic circles to describe a jamming or impaction injury of the great toe joint. Turf toe caused by a direct injury to the joint may or may not initially be obvious. Athletes may not remember an incident of pain since they’re often distracted by the event or game in which they’re involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. Turf toe pain will subside with rest only to recur with increased activity. It’s not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

Turf toe is also called hallux limitus or a dorsal bunion.  Turf toe represents just one of the four reasons that patients may develop hallux limitus. Those four reasons include;turf_toe

  • Direct physical injury to the great toe joint (turf toe) - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ.

  • Functional hallux limitus - biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ.

  • Structural hallux limitus - limited range of motion caused by a long first metatarsal.
  • Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.

It's important to understand that the terms turf toe and hallux limitus are indeed similar but aren’t synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles that refers to an injury of the great toe joint. On the other hand, when we discuss hallux limitus, we’re actually referring to a broader, ‘non-athletic’ patient population and need to include all four causes of hallux limitus.

Turf toe is graded in severity ranging from grade 1 through grade 4.  The following chart describes the clinical appearance, x-ray findings and corresponding treatment for each of the four stages of turf toe. 

Characteristic Findings By Stage Of Turf Toe.
  Symptoms External appearance of the joint X-ray findings Treatment
Stage 1 Vague joint pain. No change evident. No changes noted. Dancer's pad or sub 1 cut out in an orthotic.
Stage 2 Increased frequency and duration of pain. Mild dorsal exostosis. Dorsal exostosis on lateral x-ray.   turf_toe Carbon plate with Morton's extension. Possible joint revision.
Stage 3 Pain with all activities. Large dorsal exostosis. Increased dorsal exostosis. Asymmetrical joint spaceturf_toe
narrowing.
Youngswick osteotomy with joint revision.
Stage 4 Significant pain with any range of motion of the joint. Enlargement of the entire joint. Flattening of the joint with prolific spurringturf_toe surrounding the entire joint. Joint replacement, fusion or Keller bunionectomy.

 

Treatment of turf toe

Treatment of turf toe may include rest, shoe modifications, orthotics, steroid injections or surgery. The success of non-surgical care will vary with the severity of the initial injury, the current stage of injury, the rate at which the injury is healing and the general health of the patient.

In stage 1 turf toe, use of a dancer's pad can decrease pain by plantarflexing the first metatarsal, thereby increasing the range of motion of the great toe joint. A turfturf_toe_plate toe strap can help in stage 2 to limit motion of the joint. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Most successful are orthotics with a rigid Morton's extension beneath the great toe joint. A Morton's extension is used to decrease the range of motion of the joint. Alternatively, a full length, rigid, carbon graphite spring plate may also be used to limit range of motion of the great toe joint.

turf_toe_surgeryIf a patient does not respond to conservative care of turf toe in a reasonable time period, there are several choices of surgical procedures that may be used to treat turf toe.  The most common surgical procedure addresses cases of turf toe in stages 2 &3.  This procedure is called a Youngswick modification of an Austin bunionectomy.  The Youngswick modification is used to shorten and plantarflex the 1st metatarsal as seen in the imageturf_toe_x-ray to the left. This procedure is performed on an outpatient basis in either a hospital or surgery center.  The procedure is performed using either a general or local anesthetic with sedation.  Patients are able to bear partial weight the day of surgery.  Return to moderate athletic activities is realized in approximately 6 weeks. The following images show a Youngswick modification of an Austin bunionectomy for the treatment of stage 2 turf toe.  The post-operative x-ray to the right shows the shortening of the 1st metatarsal following the procedure.

turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery turf_toe_surgery

turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery

Stage 4 turf toe represents complete destruction of the joint surfaces.  Stage 4 turf toe can be treated by either implant arthroplasty or joint fusion.  The choice between implant arthroplasty or fusion for the correction of stage 4 turf toe is open to debate.  The choice of procedure depends, in part upon your doctor's training and philosophical approach to theturf_toe_surgery treatment of stage 4 turf toe. Patients considering these procedures should discuss treatment options for stage 4 turf toe with their doctor pe-operatively. 

The follow images show the steps necessary to complete implant arthroplasty of the great toe joint for cases of stage 4 turf toe.  This procedure is completed in either a hospital or surgery center using a general anesthetic or IV sedation with local anesthetic.  The procedure takes approximately 45 minutes to complete.  Patients are able to bear full weight the day of surgery.  Most patients return to an enclosed shoe at 3-4 weeks post-op.

turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery

turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery  turf_toe_surgery

 

   


 

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Forefoot Pain

Description:

foot_anatomy_bones_forefootThe internal support and structure of the forefoot consists of five metatarsal bones that originate in the midfoot and descend at an angle to meet the toes. Each of the five metatarsal bones terminate at the metatarsal phalangeal joints (mpj's). The plantar, or bottom aspect of the mpj is often called the ball of the foot. Due to the amount of load bearing applied to the forefoot in walking and running, the forefoot is prone to a number of different injuries.foot_anatomy_plantar_surface

The distal portion of the forefoot consists of the 1st mpj and the lesser mpj's (2-5). The great toe joint (1st mpj) is a bit unique in that the anatomy of the great toe joint is a bit different than that of the lesser mpj's. To a degree, the lesser mpj's act independently of the 1st mpj. Therefore , any discussion of forefoot conditions should be broken into those problems specific to the 1st mpj and those problems specific to the lesser mpj's (2-5).

The following is a list of common forefoot conditions. To find more information about these conditions, follow the highlighted link.

Forefoot conditions specific to the 1st mpj.

1. Bunion
2. Gout
3. Hallux limitus
4. Hallux rigidus
5. Pseudogout
6. Sesamoid fractures
7. Sesamoiditis
8. Turf toe

Forefoot conditions specific to the lesser mpj's (2-5).

1. Bursitis
2. Capsulitis
3. Freiberg's Infraction
4. Metatarsalgia
5. Morton's Neuroma
6. Metatarsal stress fractures
7. Tailors%20bunion


 

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Foot and Ankle Surgery

Description:

The following are links to pages in Myfootshop.com that contain pictures of foot and ankle surgeries.

Achilles tendonitis, insertional

Anterior_tarsal_tunnel_syndrome_surgery Anterior tarsal tunnel syndrome.

Austin_bunionectomy_surgery Austin bunionectomy with screw fixation.

Baxter's_nerve_release_surgery Baxter's nerve dissection for Baxter's nerve entrapment.

Brostrom_lateral_ankle_surgery Brostrom lateral ankle stabilization.

Charcot_joint_surgery Charcot joint reconstruction.

common_peroneal_nerve_external_neurolysis Common peroneal nerve release.

Dwyer_osteotomy Dwyer osteotomy of the heel.

EDIN_surgery_for_Morton's_neuroma Endoscopic decompression of Morton's neuroma (EDIN).

Endoscopic_gastrocnemius_surgery Endoscopic gastrocnemius recession. Video!

endoscopic_plantar_fasciotomy_surgery Endoscopic plantar fasciotomy. Video!

Ganglionic_cyst_surgery Ganglionic cyst excision.

Glomus_tumor_surgery Glomus tumor excision.

Hallux_rigidus_surgery Hallux rigidus correction with implant.

Jacoby_metatarsal_osteotomy_surgery Metatarsal osteotomy (Jacoby).

Modified_Kidner_surgery Modified Kidner procedure.

Mucoid_cyst_surgery Mucoid cyst excision

Jones_fracture_surgery ORIF Jones fracture, 5th metatarsal.

Fifth_(5th)_metatarsal_fracture_surgery ORIF spiral oblique fracture, 5th metatarsal.

calcaneal_fracture_surgery Open reduction with internal fixation (ORIF) of a complex calcaneal fracture.

peroneus_brevis_tendon_surgery Peroneus brevis tendon rupture repair.

pigmented_villonodular_synovitis Pigmented villonodular synovitis, excision.

plantar_fibromatosis_surgery Plantar fibromatosis excision.

Hammer_toe_surgery Post arthroplasty for hammer toe correction.

Selective denervation of the sural nerve.

STA_Peg_surgery Subtalar arthroeresis (STA-Peg procedure). Video!

tailor's_bunionectomy Tailor's bunionectomy. Video!

talar_dome_fracture_surgery Talar dome fracture repair (medial approach) with 1st metatarsal phalangeal osteochondral graft.

Tarsal_tunnel_surgery Tarsal tunnel decompression (release) for tarsal tunnel syndrome.

tibial_sesamoidectomy Tibial sesamoidectomy

Topaz_Achilles_tendon_surgery Topaz micro-debridement Achilles tendon surgery

Hallux_limitus_surgery Youngswick modification of an Austin bunionectomy used for correction of hallux limitus.


 

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Tailors Bunion

Description:

tailor's_buniontailor's_bunionA tailor's bunion is a prominence of the lateral aspect of the 5th metatarsal head. The term tailor's bunion was coined in the age when a tailor would sit cross legged on the floor putting up the hem on a coat or dress. The constant pressure applied to the lateral aspect of the foot resulted in pain at the 5th metatarsal head. Tailor's bunions also go by the name bunionette or baby bunion.

The most common cause of pain with a tailor's bunion is direct pressure to the lateral aspect of the 5th metatarsal head from tight shoes. Pressure from shoes will initially present as a red spot or blister over the 5th metatarsal head. If pressure persists, a bursa can form over the 5th tailor's_bunionmetatarsal head. A bursa is a stailor's_bunionmall fluid filled sac that forms in response to chronic pressure against the bone. Bursitis, or inflammation of the bursa is commonly found in conjunction with a tailor's bunion.tailor's_bunion

The shape of the 5th metatarsal can also contribute to the presence of a tailor's bunion. Lateral bowing of the 5th metatarsal can make the forefoot much wider. This can make shoe fitting much more difficult. Bowing is a significant issue to be considered when electing to perform surgery for a tailor's bunion.


Treatment of Tailor's Bunions

Conservative care for a tailor's bunion includes padding and the use of wider, softer shoes. Shoes can be spot stretched with a ring and ball stretcher to make the area of the shoe adjacent to the tailor's bunion a bit wider (ask your local pedorthist or shoe repair shop for help on spot stretching). Another important consideration is the shape of the toe box of the shoe. When buying shoes, be sure to buy a shoe with a toe box that is shaped like your foot. To be sure the toe box is shaped like your foot, stand in your socks next to the new shoe and compare the shape of your foot and the shape of the toe box. If the two don't seem to be the same shape, then perhaps that's not the right pair of shoes for you.

tailor's_bunionPlaning for surgical treatment of a tailor's bunion depends upon the degree to which the 5th metatarsal is bowed. With minimal bowing, a simple partial metatarsaltailor's_bunion head resection can be performed. A partial metatarsal head resection removes the lateral head of the 5th metatarsal. In cases of mild to moderate bowing, a distal metatarsal osteotomy is performed in conjunction with the partial head resection. Severe cases of bowing require a mid-shaft osteotomy with plating.

tailor's_bunionAnother procedure used to treat a tailor's bunion is a 5th metatarsal head resection. This procedure will result in the shortening of the 5th toe but is great in the patient population who cannot tolerate a period of non-weight bearing or casting. Patients with co-morbidities that may effect the surgery may be candidates for a 5th metatarsal head resection. Examples of these co-morbidities include obesity, severe arthritis, propensity to DVT and gait abnormalities. This is a population of patients that you want to keep as ambulatory as possible to prevent post-op complications. Diabetic patients also do quite well with 5th metatarsal head resections.

Another important consideration in planing tailor's bunion surgery is to be sure that the surgery is consistent with the location of the problem. Pain at the 5th metatarsal head can be due to pressure on the side of the metatarsal head, the bottom of the metatarsal head or both. A partial metatarsal head resection will only address pain on the lateral aspect of the 5th metatarsal head. To treat pain found on both the lateral aspect of the 5th metatarsal head and the bottom of the metatarsal head, a 5th metatarsal osteotomy or metatarsal head resection must be performed.

The following video shows a tailor's bunionectomy with 5th metatarsal osteotomy.



Tailor's bunion surgery can be performed on an out-patient basis at a hospital or surgery center. The most common anesthesia used for this procedure is a local anesthetic with sedation. General or spinal anesthetics may also be used based upon the surgeon's preference. The procedure takes approximately 20-30 minutes to perform. The post operative course varies based upon the procedure performed. Patients who undergo a partial head resection are able to bear weight on the foot the same day. Partial head resections with an osteotomy may be able to partially bear weight and are likely on crutches for several weeks. Plating for severe deformities will require a hard cast and non-weight bearing for a period of at least 6 weeks. Return to normal shoes and activities also depends upon the choice of procedure.


 

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