Bunions (hallux valgus) are not only a problem from an esthetic point of view, they are also a pathology that can affect anyone and cause serious problems ranging from intense pain to difficulty in walking. But the main question is how to stop a bunion from developing? And in which cases surgery is necessary? In order to get answers to all of these questions we have talked with Dr. Michele Risi, foot and ankle surgeon in Orthopedics and traumatology department at Salus Hospital of Reggio Emilia.
What is a hallux valgus?
A hallux valgus is a progressive deformity, commonly known as a bunion. This condition occurs when there is medial deviation of the first metatarsal and lateral deviation of the great toe (hallux). This deformation is usually associated with inflammation of mucous membrane at the base of the big toe. From an etiological point of view, the origin of the hallux valgus is attributable to intrinsic factors, like genetically determined conditions, such as flat foot or claw foot, and extrinsic factors, are widely connected to the use of inappropriate footwear. Research suggests that bunions can be hereditary, especially when they appear in adolescence. Alongside with the genetic factors an incorrect footwear plays a crucial part in development of this condition.
What’s to look out for?
A bunion is a bony bump that forms on the joint at the base of your big toe. It forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out. The skin over the bunion might be red and sore. The signs and symptoms of a bunion include: a bulging bump on the outside of the base of your big toe, swelling, redness or soreness around your big toe joint, corns or calluses — these often develop where the first and second toes overlap, persistent or intermittent pain, restricted movement of your big toe if arthritis affects the toe. Bunions can cause other complications such as, bursitis- this painful condition occurs when the small fluid-filled pads (bursae) cushions between the bones, tendons and muscles near your joints become inflamed. Hammertoe is a type of complication that causes an abnormal bend that appears in the middle joint of a toe, usually the toe next to your big toe, this can be a rather painful condition and cause a lot of discomfort. Metatarsalgia is another type of complication that can occur, this condition causes pain and inflammation in the ball part of your foot.
Who is most affected?
Women are much more effected by this condition compare to men with a ratio of 15 : 1. This condition can occur at any age, but the group that’s most affected is between 40 and 60 years old, but lately there been a rise in 40-50 year olds age group. However, there are cases of young adults been affected by this condition, in the 20-25 age group, there are also cases of this condition appearing much later in life, often in conjunction with degenerative diseases such as arthrosis.
Is it possible to prevent bunions?
Unfortunately, it is difficult to prevent them. And you should understand that cosmetic issues are not sufficient enough grounds to warrant a surgery. First course of action, in fact, would be conservative therapy: the use of appropriate and comfortable shoes with low heel that are widely fitted, braces or other special medical equipment, but also painkilling or orthotics are used. Especially with metatarsalgies or flat foot on a top of this condition. When prescribing a treatment, we must take in to consideration numerous factors such as, patient's age group, severity degree of the condition, presence or absence of pain and also the propensity to use some types of footwear, whilst taking in the account patients lifestyle. If conservative therapies do not work, it will be necessary to proceed with the surgery.
What are the main diagnostic and investigation methods?
Of course we always begin with the primary diagnostic visit, this is when the doctor evaluates the patient's condition. At this stage, the doctor observes the mode of supporting the forefoot and hindfoot. X-rays are performed while the patient is standing, to enable an assessment of the pathology under pressure. After the first visit, specialist may require additional studies: among which would be an ultrasound, the MRI, or CT scan. Operation is always the last resort.
When surgery is necessary?
If conservative therapy dose not prove to be beneficial and the patient will continue to suffer from pain, only then it will be necessary to resort to surgery. In this case I must, note that we prefer to intervene with a minimally invasive methods of operation: the Percutaneous Bianchi System (PBS). It is a percutaneous technique that allows to correct the hallux valgus by means of small cuts, this method derives from a dental treatment that uses burs, incisions of 2-3 millimeters are made on the affected area. The surgeon guides and controls the whole procedure through a particular X-ray device. This allows to perform a less invasive surgery, it significantly reduces the time of surgery, immediate mobility and fast recovery are guaranteed. But the most important fact in this innovative method, is the absence of synthetic elements, such as screws or wires. This enables the fractures to heal naturally.
What about postoperative treatment?
After surgery the patient must use special postoperative shoes and a special bandage. Patient is able to walk immediately. After 20 days, patient must come in for the first control visit during which the dressing is changed, flow up treatment includes reduction use of bandage and a special “sock PBS”. This allows the patient to once again wear comfortable athletic shoes. In some cases, more check-ups are applied depending on the severity of the condition, and finally after 45 days we proceed with the X-ray control.
If you require further information or want to book a visit with our specialist, Zayceva Evgenia, please call on +7 (495) 120 79 61 or on +7 (985) 956 54 10.