Bunions Hallux Valgus - Patient Education - Orthogate




Bunions Hallux Valgus - Patient Education - Orthogate

What can be done for the condition?

Nonsurgical Treatment
Treatment of hallux valgus nearly always starts with adapting shoewear to fit the foot. In the early stages of hallux valgus, convertingfrom a shoe with a pointed toe to a shoe with a wide forefoot (or toe box)may arrest the progression of the deformity. Since the pain that arisesfrom the bunion is due to pressure from the shoe, treatment focuses onremoving the pressure that the shoe exerts on the deformity. Widershoes reduce the pressure on the bunion. Bunion pads may reducepressure and rubbing from the shoe. There are also numerous devices,such as toe spacers, that attempt to splint the big toe and reverse thedeforming forces.

Surgery
If all nonsurgical measures fail to control the symptoms, thensurgery may be suggested to treat the hallux valgus condition. Wellover 100 surgical procedures exist to treat hallux valgus. The basicconsiderations in performing any surgical procedure for hallux valgusare
to remove the bunionto realign the bones that make up the big toeto balance the muscles around the joint so the deformity does not returnBunionectomy
In some very mild cases of bunion formation, surgery may only berequired to remove the bump that makes up the bunion. This operation,called a bunionectomy, is performed through a small incision onthe side of the foot immediately over the area of the bunion. Once theskin is opened the bump is removed using a special surgical saw orchisel. The bone is smoothed of all rough edges and the skin incisionis closed with small stitches.

It is more likely that realignment of the big toe will also benecessary. The major decision that must be made is whether or not themetatarsal bone will need to be cut and realigned as well. The anglemade between the first metatarsal and the second metatarsal is used tomake this decision. The normal angle is around nine or ten degrees. Ifthe angle is 13 degrees or more, the metatarsal will probably need tobe cut and realigned.

When a surgeon cuts and repositions a bone, it is referred to as an osteotomy. There are two basic techniques used to perform an osteotomy to realign the first metatarsal.
Distal Osteotomy
In some cases, the far end of the bone is cut and moved laterally (called a distal osteotomy).This effectively reduces the angle between the first and secondmetatarsal bones. This type of procedure usually requires one or twosmall incisions in the foot. Once the surgeon is satisfied with theposition of the bones, the osteotomy is held in the desired positionwith one, or several, metal pins. Once the bone heals, the pin is removed. The metal pins are usually removed between three and six weeks following surgery.
Proximal Osteotomy
In other situations, the first metatarsal is cut at the near end of the bone (called a proximal osteotomy).This type of procedure usually requires two or three small incisions inthe foot. Once the skin is opened the surgeon performs the osteotomy.The bone is then realigned and held in place with metal pins until it heals. Again, this reduces the angle between the first and second metatarsal bones.

Realignment of the big toe is then done by releasing the tightstructures on the lateral, or outer, side of the first MTP joint. Thisincludes the tight joint capsule and the tendon of the adductor hallucis muscle.This muscle tends to pull the big toe inward. By releasing the tendon,the toe is no longer pulled out of alignment. The toe is realigned andthe joint capsule on the side of the big toe closest to the other toeis tightened to keep the toe straight, or balanced.

Once the surgeon is satisfied that the toe is straight and wellbalanced, the skin incisions are closed with small stitches. A bulkybandage is applied to the foot before you are returned to the recoveryroom.

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