Tag Archives: Hallux

Bunions

Definition:
A bunion is an enlargement of bone or tissue around the joint at the base of the big toe (metatarsophalangeal joint).The big toe (hallux) may turn in toward the second toe (angulation), and the tissues surrounding the joint may be swollen and tender.

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The term is used to refer to the pathological bump on the side of the great toe joint. The bump is partly due to the swollen bursal sac and/or an osseous (bony) anomaly on the mesophalangeal joint (where the first metatarsal bone and hallux meet). The larger part of the bump is a normal part of the head of first metatarsal bone that has tilted sideways to stick out at its top.

Although they’re more common in older people, they can begin at any age, and even children can develop them. A similar bump, but on the outer edge of the foot at the base of the smallest toe, is known as a bunionette.

The term “hallux valgus” or “hallux abducto-valgus” are the most commonly used medical terms associated with a bunion anomaly, where “hallux” refers to the great toe, “valgus” refers to the abnormal angulation of the great toe commonly associated with bunion anomalies, and “abductus/-o” refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunions. It is important to state that “hallux abducto refers to the motion the great toe moves away from the body’s midline. Deformities of the lower extremity are usually named in accordance to the body’s midline, or the line bisecting the body longitudinally into two halves.

Bunions most commonly affect women. Some studies report that bunions occur nearly 10 times more frequently in women then men.

Symptoms:
Bunions may or may not cause symptoms. A frequent symptom is pain in the involved area when walking or wearing shoes that is relieved by resting. A bunion causes enlargement of the base of the big toe and is usually associated with positioning of the big toe toward the smaller toes. This leads to intermittent or chronic pain at the base of the big toe.

Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, and local tenderness.

The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.

Having bunions can also make it harder to find shoes that fit properly; bunions may force a person to have to buy a larger size shoe to accommodate the width the bunion creates. When bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes because it then becomes a mechanical function problem of the forefoot.

Risk Factors & Causes:
It is found  that tight-fitting shoes, especially high-heel and narrow-toed, might increase the risk for bunion formation.
Bunions are reported to be more prevalent in people who wear shoes than in barefoot people. There also seem to be inherited (genetic) factors that predispose to the development of bunions, especially when they occur in younger individuals.

Other risk factors for the development of bunions include congenital (present from birth) abnormal formation of the bones of the foot, nerve conditions that affect the foot, rheumatoid arthritis, and injury to the foot. Bunions are common in ballet dancers.

Bunions are mostly genetic and consist of certain tendons, ligaments, and supportive structures of the first metatarsal that are positioned differently. This bio-mechanical anomaly may be caused by a variety of conditions intrinsic to the structure of the foot – such as flat feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions. These factors are often considered genetic. Although some experts are convinced that poor-fitting footwear is the main cause of bunion formation, other sources concede only that footwear exacerbates the problem caused by the original genetic structure.

Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position. Arthritis of the big toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development.

Diagnosis:
A doctor can usually diagnose a bunion by looking at it. A foot x-ray can show an abnormal angle between the big toe and the foot and, in some cases, arthritis.

The doctor considers a bunion when noting the symptoms described above. The anatomy of the foot is assessed during the examination. Radiographs (x-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes.

Treatment:
Bunions may be treated conservatively with changes in shoe gear, different orthotics (accommodative padding and shielding), rest, ice, and medications. These sorts of treatments address symptoms more than they correct the actual deformity. Surgery, by an orthopedic surgeon or a podiatrist, may be necessary if discomfort is severe enough or when correction of the deformity is desired.

Orthotics are splints, regulators while conservative measures include various footwear like gelled toe spacers, bunion / toes separators, bunion regulators, bunion splints, and bunion cushions.

Surgery:
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion. For instance, procedures may address some combination of:

*removing the abnormal bony enlargement of the first metatarsal,
*realigning the first metatarsal bone relative to the adjacent metatarsal bone,
*straightening the great toe relative to the first metatarsal and adjacent toes,
*realigning the cartilagenous surfaces of the great toe joint,
*addressing arthritic changes associated with the great toe joint,
*repositioning the sesamoid bones beneath the first metatarsal bone,
*shortening, lengthening, raising, or lowering the first metatarsal bone, and
*correcting any abnormal bowing or misalignment within the great toe.

At present there are many different bunion surgeries for different effects. Ultimately, surgery should always have function of the foot in mind besides its look. Can the proposed surgery help resolve the pain and callus under the middle metatarsal heads? Can one return to sports? Can the foot enjoy fashionable or high heel shoes like normal feet without undue discomfort? Does the proposed surgery prevent recurrence with any specific built-in mechanism? These are very reasonable challenges for any truly functional bunion surgeries but may not be so for esthetic bunion surgeries.

The age, health, lifestyle, and activity level of the patient may also play a role in the choice of procedure.

Bunion surgery can be performed under local, spinal, or general anesthetic. The trend has moved strongly toward using the less invasive local anesthesia over the years. A patient can expect a 6- to 8-week recovery period during which crutches are usually required for aid in mobility. An orthopedic cast is much less common today as newer, more stable procedures and better forms of fixation (stabilizing the bone with screws and other hardware) are used.

Prognosis:
The prognosis depends on your age and activities, and the severity of the bunion. Teenagers may have more trouble treating a bunion than adults. Many adults do well by caring for the bunion when it first starts to develop, and wearing different shoes. Surgery reduces the pain in many, but not all, people with bunions.

Possible Complications:

*Chronic foot pain
*Foot deformity
*Stiff foot
*Hallux varus (occurs with surgical over-correction, where the toe points away from the second toe

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.medicinenet.com/bunions/page2.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001231.htm
http://en.wikipedia.org/wiki/Bunion
http://www.bbc.co.uk/health/physical_health/conditions/bunions.shtml

http://www.consumerreports.org/health/conditions-and-treatments/bunions/what-is-it.htm

http://www.cafai.com/bunions.html

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Balancing Builds Strength & Flexibility

If you’re familiar with the classic yoga pose called “downward facing dog,” try this variation for more of a challenge. It develops flexibility in your legs while strengthening your core and upper-body muscles.

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Step 1. Begin on your hands and knees, then curl your toes under and lift your hips to straighten your knees, pushing your heels toward the floor. Shift your weight to your left leg and raise your right leg off the floor. Keep your right foot flexed, with your toes and knee pointed down.

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Step 2.  Focus on keeping your shoulders and hips facing the floor as you shift your upper-body weight to your right hand. Slowly raise your left arm off the floor while you use your core muscles to stabilize your shoulders and pelvis. Find your balance and hold for three complete breaths. Slowly lower your arm and leg, then switch sides and repeat the exercise on the other side.

Sources: Los Angeles Times

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Ingrown Toenail

An ingrown toenail is a toenail that has grown into the skin instead of over it. This usually happens to the big toe, but it can also happen to other toes. An ingrown toenail can get infected. It may be painful, red, and swollen, and it may drain pus. See an illustration of an ingrown toenail….CLICK & SEE THE PICTURES
It occurs when a nail grows into the flesh at the side of the nail. This usually affects the toes, particularly the big toe. People with curved or thick nails are most likely to develop a problem with ingrown nails, although ingrown nails can affect anyone.

Anyone can get an ingrown toenail, but adults get them more than children do. People who have curved or thick nails are more likely to get an ingrown toenail. This is more common in older adults.

Causes:

An ingrown toenail can have a number of different causes. Cutting your toenail too short or rounding the edge of the nail can cause it to grow into the skin. Wearing shoes or socks that don’t fit well can also cause an ingrown toenail. If your shoes are too tight, they might press the nail into the toe and cause it to grow into the skin.

You can get an ingrown toenail if you hurt your toe, such as stubbing it. This can cause the nail to grow inward. Repeating an activity that injuries the nail, such as kicking a soccer ball, can also cause an ingrown nail.

Ingrown toenails result when the nail grows into the flesh of your toe, often the big toe. Common causes include:

  • Wearing shoes that crowd your toenails
  • Cutting your toenails too short or not straight across
  • Injury to your toenail
  • Unusually curved toenails
  • Thickening of your toenails

An ingrown toenail can result from curved toenails, poorly fitting shoes, toenails that are trimmed improperly, or a toe injury. The skin around the toenail may become red and infected. The great toe is usually affected, but any toenail can become ingrown.

The condition may become serious in people with diabetes.

Symptoms:

Signs and symptoms of an ingrown toenail include:

*Pain and tenderness in your toe along one or both sides of the nail
*Redness around your toenail
*Swelling of your toe around the nail
*Infection of the tissue around your toenail

Risk factors:

Anyone can develop an ingrown toenail. But you may be more prone to ingrown toenails if you have toenails that curve down.

Ingrown toenails are also more common in older adults, because nails tend to thicken with age. This thickening or change of the curvature of your nails can cause ingrown toenails.

Complications:

Left untreated or undetected, an ingrown toenail can infect the underlying bone and lead to a serious bone infection.

Complications can be especially severe if you have diabetes because the circulation and nerve supply to your feet can be impaired. Therefore, any relatively minor injury to your foot — cut, scrape, corn, callus or ingrown toenail — can lead to a more serious complication. In rare cases, an ingrown toenail can result in a difficult-to-heal open sore (foot ulcer), which could eventually require surgery. Foot ulcers left untreated may become infected and eventually even gangrenous. Rarely, amputation is the only treatment option.

Exams and Tests:
A doctor’s examination of the foot is sufficient to diagnose an ingrown toenail.

Treatment:

To treat an ingrown nail at home:

  1. Soak the foot in warm water.
  2. Use a nail file to separate the nail from the inflamed skin.
  3. Place a small piece of cotton under the nail. Wet the cotton with water or antiseptic.

Repeat those steps, several times a day if necessary, until the nail begins to grow out and the pain goes away. Also, trim the toenail and apply over-the-counter antibiotics. If this does not work and the ingrown nail gets worse, see a foot specialist (podiatrist) or skin specialist (dermatologist).

If steps you take at home don’t help, your doctor can treat an ingrown toenail by trimming or removing the ingrown portion of your nail to help relieve pain. Before this procedure, your doctor numbs your toe by injecting it with an anesthetic. After the procedure, you may need to rest your foot and soak it in warm water. Your doctor may also recommend using topical or oral antibiotics for ingrown toenail treatment, especially if the toe is infected or at risk of becoming infected.

For a recurrent ingrown toenail, your primary doctor or foot doctor may suggest removing a portion of your toenail along with the underlying tissue (nail bed) to prevent that part of your nail from growing back. This procedure can be done with a chemical, a laser or other methods.

Prognosis:
Treatment will generally control the infection and relieve pain. However, the condition is likely to return if measures to prevent it are not taken. Good foot care is important to prevent recurrence.

Prevention :

To prevent an ingrown toenail:

  • Wear shoes that fit properly.
  • Trim toenails straight across the top and not too short.
  • Keep the feet clean and dry.
  • People with diabetes should have routine foot exams and nail care.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.revolutionhealth.com/articles/ingrown-nail/tp12748
http://www.mayoclinic.com/health/ingrown-toenails/DS00111/DSECTION=4
http://www.nlm.nih.gov/medlineplus/ency/article/001237.htm