Bunions Flashcards
What is the medical term for bunions?
Hallux valgus
What are bunions?
deformity in the first metatarsophalangeal joint
What are bunions characterised by?
Medial deviation of the first metatarsal and lateral deviation with or without rotation of the hallux with associated joint subluxation
How are digits made to stay parallel with the long axis of the foot?
Balance of static stabilisers (bone and ligaments) and dynamic stabilisers (muscles and tendons)
Once the metatarsal head escapes from the intrinsic anatomical control, the extrinsic tendons become what?
a deforming force, causing the first metatarsal head to drift medially, this tension cause the bone to proliferate on the dorsomedial aspect of the head of the first metatarsal and the cartilage is affected by the subsequent remodelling
What can increase chances of having bunions?
Female, connective tissue disorders, hyper mobility syndromes, anatomical variants, genetic predisposition, environmental factors and wearing high heels
What are the clinical features of bunions?
painful medial prominence, aggravated by walking, weight bearing, wearing narrow toes shoes
What would you look for on examination of bunions?
position and lateral deviation of the hallux, inflammation, skin breakdown, range of movement, crepitus, contracture of the extensor hallucis longus tendon may be visible on joint subluxation and any excessive keratosis may be a sign of abnormal weight distribution from an altered gait
What are the differential diagnosis of bunions?
gout, septic arthritis, hallux rigidus, osteoarthritis, RA
what is the normal range of movement in both the dorsal and plantar direction from neutral of the 1st metatarsal?
5mm
how much movement should there be in the transverse plane of a 1st metatarsal?
none
What are the investigations done if bunions are suspected?
radiographic imaging shows the degree of lateral deviation and signs of joint subluxation
How is the angle of a bunion measured?
Angle between the 1st metatarsal and the 1st proximal phalanx, hallux values is diagnosed if the angle is greater than 15 degrees
What is the conservative treatment for bunions?
Analgesia, adjusting footwear, orthosis, physiotherapy
What is the surgical management for bunions?
Chevrons procedure, scarf procedure, lipids procedure, keller procedure
