Posts for tag: Podiatrist

A bunion is a bump on the joint of the big toe — called the metatarsophalangeal (MTP) joint — that forms when the bone or tissue on that joint moves out of place and extends out beyond the normal anatomical curvature of the toe. Because this joint carries much of the body’s weight while walking, bunions can cause debilitating pain if left untreated. Unfortunately, bunions do not go away over time. In fact, if you ignore it, the condition will only get worse ... and worse ... until the pain is so debilitating you have no choice but to see a podiatrist.

Bunions are brought about by years of abnormal motion and pressure on the MTP joint brought on by the way we walk, our genetic foot type or our shoe choices. People who suffer from flat feet or low arches are also at added risk along with arthritic patients and those with inflammatory joint disease. Typically, we treat many younger women who have been wearing ill-fitting shoes (the wrong size or styles which squeeze toes together) and athletes wearing the wrong size athletic shoe apparel.

How can I get rid of it?

We will initally recommend selecting a shoe with a wide and deep toe box. Stay away from shoes with heels higher than two inches. Custom Orthotics may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity. Apply an over-the-counter, non-medicated bunion pad around the bunion any time you wear a shoe. If your bunion is inflamed and sore, apply ice packs several times a day to reduce swelling.

If these initial efforts fail, it’s time to see a podiatrist who specializes in bunion therapy. Initially, the podiatrist may prescribe an anti-inflammatory drug and/or cortisone injection to reduce pain and inflammation. Ultrasound therapy is also a popular technique for treating soft tissue damage.

Surgical options for the most serious bunions

When these doctor-prescribed therapies fail, podiatric surgery may be needed to permanently relieve pressure and repair the toe joint. A bunionectomy will remove the bony enlargement, restore the normal alignment of the toe joint, and alleviate the pain. But understand, the short-term recovery from this type of surgery takes time and discomfort can last several weeks. 

Prevention tips

The best defense against bunions is to prevent them:

• Avoid shoes with pointed triangular tips and wearing high heels for extended periods of time each day.

• Know your “real” shoe size (today) which can increase with age, weight gain and pregnancy.

See a board-certified podiatrist at the first sign of a bunion deformity.

Like any medical condition, treating bunions early on saves time, discomfort and money down the line. Seek treatment now before the condition worsens and a more invasive course of action is needed.

By Dr. Brad Legge
January 22, 2014

Fifteen years ago while I was visiting my parents in Wales, my mother slipped and fell down a few stairs twisting her foot. She was in a terrific amount of pain so we took her to Casualty (ER). They x-rayed her foot and diagnosed her with a Jones fracture. This rather well known fracture was first described Sir Robert Jones (a fellow Welshman) who sustained this injury himself while dancing in 1902. He wrote a paper in the Annals of Surgery that same year describing the fracture in himself and 5 other individuals.  Initially he thought he may have torn his Peroneus Longus tendon (a tendon on the outside of the foot) but he felt the tendon and found it to be intact.  Although x-rays were relatively new at that time he suspected bone involvement and asked his colleague Dr. David Morgan to take radiographs of his foot. Examination of the radiographs revealed a fracture, 3/4 of an inch distal to the fifth metatarsal base (at the metaphyseal-diaphyseal junction). He was surprised that this fracture did not occur due to direct trauma but rather a cross-strain applied to the bone. The mechanism of injury was forced inversion (twisting in) of the foot when the ankle is tilted down (plantar flexed) and the weight is on the outside ball of the foot. These fractures are known to be relatively poor healers due to diminished blood supply at the metaphyseal-diaphyseal junction of the fifth metatarsal.










Treatment:


Conservative care for a non-displaced acute Jones fracture usually involves non-weightbearing in a cast for 6-8 weeks; however, many doctors recommend surgical repair of this fracture in more active individuals, athletes, or in cases where the fracture is chronic in nature. Surgical repair will often increase the healing rate and decrease the risk of re-injury. Surgical techniques vary. Often a small incision is used to place a guide wire in the bone followed by a cannulated screw down the intramedullary canal of the fifth metatarsal bone.








Sometimes for chronic fracture non-unions (where a fracture has failed to heal over a period greater than 6 months) a metallic plate may be used with or without a bone graft. 



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