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Juvenile Hallux Abducto Valgus

Overview
Bunions
Bunions are a common problem that most individuals experience as a painful swelling or a bony protuberance at the inner base of the big toe. This condition is the result of a malalignment of the first toe. These can be hereditary or secondary to wearing high-heeled or narrow toe-box shoes.


Causes
Women traditionally have a higher rate of bunions, which is to be expected, since it is they who have traditionally worn shoes with high heels, a narrow toe box, or whatever fashion dictates from year to year. However, men can suffer from bunions as well, as can anyone for whom the right (or wrong) conditions exist, poor foot mechanics, improper footwear, occupational hazards, health and genetic predisposition. Finally, bunions have long been a condition associated with the elderly, and although they often appear in conjunction with inflammatory joint diseases such as arthritis (which is often associated with age), they can strike at any point in life, including adolescence.


Symptoms
With the positional change of the hallux, pain is a common occurrence. As the foot goes through the gait cycle the hallux plays an integral role as the body’s weight transmits through during propulsion. With this in mind, it easy to see how the change in the hallux joints (metatarsal phalangeal joint and the proximal interphalangeal) would cause joint narrowing and early degeneration of the articular cartilage. In addition, two small bones (ossicles) found underneath just behind the joint will start placing extra pressure on the metatarsal. Along with bony changes, there are many soft tissue changes as the hallux and metatarsal reposition, which causes added strain to other bony structures and can accelerate the problem.


Diagnosis
A thorough medical history and physical exam by a physician is necessary for the proper diagnosis of bunions and other foot conditions. X-rays can help confirm the diagnosis by showing the bone displacement, joint swelling, and, in some cases, the overgrowth of bone that characterizes bunions. Doctors also will consider the possibility that the joint pain is caused by or complicated by Arthritis, which causes destruction of the cartilage of the joint. Gout, which causes the accumulation of uric acid crystals in the joint. Tiny fractures of a bone in the foot or stress fractures. Infection. Your doctor may order additional tests to rule out these possibilities.


Non Surgical Treatment
Fortunately, many bunions never go on to cause problems other than the cosmetic appearance. The easiest option is to try different shoes or padding, however this is not the answer for everyone. The various straps and braces that are commercially available are not proven to be particularly effective.
Bunions Callous


Surgical Treatment
Larger bunions often require the surgeon to move the entire bone over (1st metatarsal). This is accomplished by a cut or fusion at the bottom of the bone. The former technique, is called the Lapidus bunionectomy. Additionally, the repositioned bone is held in place with one or two surgical screws.


Prevention
The best way to reduce your chances of developing a bunion is to wear shoes that fit properly. Any shoe that is too tight or too high will force your toes together and may cause the condition to develop. Shoes need to be wide enough, so they aren’t rubbing against the joint, and preferably made of leather. Avoid shoes with a lot elaborate stitching at the front, as this can also cause irritation. Heels should be no more than three to four inches and you should only wear them occasionally. Court shoes should seldomly be worn, as they do not give the foot any support. Be honest with yourself, you know if your shoes aren’t fitting you comfortably. Do something about it, or you will suffer for your vanity.

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