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Hallux Valgus

Bunion


Presentation

  • In the preoperative period, 02 children (18.2%) presented mild deformity, 08 children (72.7%) presented moderate deformity and one child (9.1%) presented severe deformity.[oatext.com]
  • Symptoms have often been present for some time before presentation, however have worsened in frequency and intensity On examination, assess position and lateral deviation of the hallux (Fig. 2) and check for evidence of inflammation or skin breakdown[teachmesurgery.com]
  • Presentation Presentation is usually as a result of pain, although the condition is also unsightly. Pain is usually progressive and may have been present for many years.[patient.info]
  • One year later she presents with the painless foot deformity shown in Figure A.[orthobullets.com]
  • The SERI technique (as abbreviated to stand for simple, effective, rapid and inexpensive) was presented by several authors to be a minimally invasive technique since it presents with the same advantages as the percutaneous techniques with less tissue[clinicaltrials.gov]
Asymptomatic
  • Frequently, the condition is asymptomatic even in the presence of the deformity. Pension Considerations On this page A. Causes And / Or Aggravation B. Medical Conditions Which Are To Be Included In Entitlement / Assessment C.[veterans.gc.ca]
  • It has been the author's experience that patients who develop a nonunion generally function well and asymptomatically once the K wires are removed.[elsevier.es]
Wound Infection
  • Commonly chosen when the first MTPJ arthritis is severe Surgical complications for all the aforementioned procedures include wound infection, delayed healing, nerve injury, and osteomyelitis. Recurrence is not uncommon.[teachmesurgery.com]
  • infections, metatarsalgia, plantar keratosis, post-operative first MTP joint arthritis, metatarsal fracture, metatarsal head osteonecrosis, symptomatic hardware and complex regional pain syndrome (CRPS). 16, 30, 32, 36 Corrective TMT arthrodesis Moderate[online.boneandjoint.org.uk]
Family History of Arthritis
  • history, rheumatoid arthritis [2] Diagnostic method Based on symptoms, X-rays [2] Differential diagnosis Osteoarthritis, Freiberg's disease, hallux rigidus, Morton's neuroma [3] Treatment Proper shoes, orthotics, NSAIDs, surgery [2] Frequency 23% of[en.wikipedia.org]
Fracture
  • Complications Possible complications of surgical procedures are too extensive shortening of the first metatarsal bone, luxation or fracture of the first metatarsal bone, aseptic necrosis of the head of the first metatarsal bone, decreasing the scope of[akromion.hr]
  • Fractures. Gout. Rheumatological disease (eg, rheumatoid arthritis ). Neuropathic pain (particularly diabetes ). Infection. Management [ 9 ] Conservative management Patients should be given appropriate information and advice about hallux valgus .[patient.info]
  • Moreover, the need for structural bone graft and the inability to achieve stable fixation resulting in fear of osteotomy fracture, malunion, or nonunion contributed to its limited use. [5] In recent years, more studies have been published in the literature[journalmsr.com]
  • Traumatic conditions that may cause hallux valgus include malunions secondary to first-metatarsal fractures with or without intra-articular damage, soft-tissue injuries of the hallux, and sequelae of dislocations.[emedicine.medscape.com]
  • […] scarf osteotomies were found in between 1.1% and 31% of cases, including nonunion, delayed union, recurrence, hallux varus, superficial and deep wound infections, metatarsalgia, plantar keratosis, post-operative first MTP joint arthritis, metatarsal fracture[online.boneandjoint.org.uk]
Joint Swelling
  • This can result in pain in the toe joint, swelling and red shiny skin over the bunion area. Cerebral palsy, a disease that affects people from birth can result in stiffness in the patient’s movement.[news-medical.net]
  • Symptoms Most individuals who have developed a bunion experience the following symptoms: A bulging bump on the base of the big toe, on the inside of the foot Thickening of the skin around the big toe joint Swelling, redness, or soreness around the big[orthopedicandfracturespecialists.com]
Withdrawn
  • A Cochrane review in 2004 found very little good evidence on which to assess either conservative or operative treatments and the update in 2009 was withdrawn [ 16 ].[patient.info]
Fear
  • Moreover, the need for structural bone graft and the inability to achieve stable fixation resulting in fear of osteotomy fracture, malunion, or nonunion contributed to its limited use. [5] In recent years, more studies have been published in the literature[journalmsr.com]

Treatment

  • Patient satisfaction with treatment and global assessments were higher for the surgery group than for patients receiving orthotics or no treatment. However, under the study protocol, patients could not be blinded to treatment.[mdedge.com]
  • Medical treatment Treatment Largely, the treatment of a hallux valgus deviation can be summarized up in a few words: “Either the patient adapts the footwear to the foot, or the foot should be adapted to your shoes!”[efas.co]
  • Treatment Treatment of bunions varies depending on the severity of the bunion and the amount of pain it causes. The initial treatment of a bunion should always be non-operative.[orthopedicandfracturespecialists.com]
  • NEXT: Treatment Options › Treatment Options Conservative Treatment for Bunions Conservative treatment is directed at protecting the bunion from pressure or friction caused by shoe wear.[mdmercy.com]
  • Non-surgical treatments Non-surgical treatments for bunions may include: Wearing shoes that fit and that have adequate toe room. Stretching shoes professionally to make them larger. Putting bunion pads over the bunion to cushion the pain.[my.clevelandclinic.org]

Prognosis

  • Treatment and prognosis Non-surgical treatment involves the use of accommodative foot wear. This is usually achieved by the use of soft and wide shoes.[radiopaedia.org]
  • Prognosis is variable in this condition as the deformity may remain stable or progress rapidly. Conservative management can help to alleviate symptoms but will never correct the deformity.[teachmesurgery.com]
  • Prognosis The outlook is highly variable, as is that of the patients who are treated. Hence there is a shortage of adequate trials to compare the outcomes of the various forms of treatment.[patient.info]
  • Prognosis Hallux valgus is a complex deformity, and various approaches are available. To date, no satisfactory studies have been performed to compare the various procedures and their success rates.[emedicine.medscape.com]

Etiology

  • The etiology of hallux Valgus may be multifactorial, and in certain cases related to such inherited tendencies as hypermobile joints, e.g. Ehlers - Danlos disease, splaying of the forefoot, and metatarsus primus varus.[veterans.gc.ca]
  • Etiology Hallux valgus is known to have numerous etiologies, including biomechanical, traumatic, and metabolic factors. The most common etiology, yet the most difficult to understand, is biomechanical instability.[emedicine.medscape.com]
  • Studies describing the incidence of hallux abducto valgus in shod and unshod populations have identified footwear as an important etiological factor (Lam Sim-Fook and Hodgson, 1958; Shine, 1965).[oandplibrary.org]
  • Meatatrsus primus varus, hyperlaxity and flat feet are most common etiologies in juvenile and acquired hallux valgus [ 5 ].[alliedacademies.org]
  • . - Hallux valgus--etiology, anatomy, treatment and surgical considerations. - Physical Exam: - vascular status: dorsalis pedis and posterior tibial artery ; - ankle equinus deformity (loss of ankle dorsiflexion may accentuate forefoot pain); - determine[wheelessonline.com]

Epidemiology

  • Epidemiology and imaging appearance of the normal Bi-/multipartite hallux sesamoid bone. Foot Ankle Int. 2015 Feb. 36 (2):197-202. [Medline]. Collan L, Kankare JA, Mattila K.[emedicine.medscape.com]
  • Epidemiology Bunions are common but the exact prevalence of bunions is difficult to ascertain. They are known to be the most common forefoot problem in adults [ 1 ]. One UK-based study found a prevalence of 28.4% in adults [ 2 ].[patient.info]
  • Introduction Not a single deformity, but rather a complex deformity of the first ray often accompanied by deformities and symptoms in lesser toe two forms exist adult hallux valgus adolescent & juvenile hallux valgus Epidemiology of adult hallux valgus[orthobullets.com]
  • Radboud, Nijmegen, The Netherlands Maarten de Waal Malefijt Dept. of Orthopedic Surgery, Maasland Hospital, Sittard, The Netherlands Frits F Draijer Dept. of Epidemiology, University of Maastricht, Maastricht, The Netherlands Rob A de Bie Authors Search[bmcmusculoskeletdisord.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • In this article, we shall look at the pathophysiology, clinical features and management of hallux valgus. Pathophysiology During the gait cycle, the digits should remain parallel to the long axis of the foot.[teachmesurgery.com]
  • - See: - adolescent bunion - bunionette - Discussion: - pathophysiology - blood supply of MCP joint - windlass mechanism - diff dx: - gout - hallux rigidus ( cheilectomy ); - references: - Anatomic variations in the first ray: Part I.[wheelessonline.com]
  • Subsequently increasing the risk of developing bunions. [4] [6] Pathophysiology [ edit ] The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint.[en.wikipedia.org]
  • Pathophysiology It is helpful to consider this, as correction of the biomechanical factors may prevent excessive pronation and progression of the deformity: When walking, the hallux and digits stay parallel to the long axis of the foot.[patient.info]
  • Pathophysiology During the gait cycle, the hallux and the digits generally remain parallel to the long axis of the foot, regardless of the degree of forefoot abduction (or pronation) occurring (see the image below).[emedicine.medscape.com]

Prevention

  • The toe separator is made of soft para rubber and prevents pain from pressure or rubbing between the toes, which may be caused for example by toe misalignments.[berkemann.com]
  • Advise on adjusting footwear to prevent the deformity from worsening and preventing irritation of the skin over the medial eminence. If the patient has flat feet, then an orthosis may help to prevent the progression of the condition.[teachmesurgery.com]
  • Prevention Correction of the biomechanical factors may prevent excessive pronation and progression of the deformity. Judicious footwear may help prevent bunions in some, but not all, cases.[patient.info]
  • Hallux valgus, a difficult disease to prevent Unfortunately, hallux valgus is difficult to prevent.[hunimed.eu]
  • While orthosis are sometimes prescribed their is minimal evidence to suggest their use will prevent the progression of the disease 6. Non-surgical treatment is deemed to have failed when the pain is no longer controlled with the suggested measures.[radiopaedia.org]

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