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Bunions: how we damage our own feet

Bunions: how we damage our own feet

Bunions are an ailment that’s very familiar to most people. In spite of this, many underestimate the first symptoms of this unpleasant and painful foot deformity.

Bunion (Latin: hallux valgus) is one of the most common orthopaedic conditions. It is characterised by a deformation of the metatarsophalangeal joint (the joint connecting the big toe to the foot) or, more rarely, the interphalangeal joint. It’s important to note that bunion is not a passing affliction; on the contrary, it’s quite difficult to treat unless dealt with in time.

Physics applies to our feet, too

Let’s imagine our joints and bones, constantly affected by an external force. Our organism adjusts their position in order to minimise its effects. However, when the force exceeds the adaptive capabilities of our bodies, pathological changes may set in in the metatarsophalangeal joint. Due to excessive pressure being applied to the phalanx (the further part of the joint), it bends in an unnatural way, while the metatarsal (a bone connected to the joint) also bends, but in the opposite direction. The entire joint becomes cone-shaped, and with time becomes a painful bunion. This often happens for both feet at once.

The patients are usually too slow to visit a doctor, because the treat it as if it was a purely cosmetic change. This couldn’t be further from the truth. Indeed, people are only able to convince themselves to treat the change as cosmetic in the very first stages of the affliction. It’s when they start having problems with wearing shoes that they decide to ask for medical attention. Unfortunately, by then usually the only solution to their problem is surgery.

A common problem

It’s estimated that bunions are present in 2–4% of the population. Women tend to be more at risk, as their feet are adversely affected by high-heeled shoes which are often maladjusted, tight and narrow-tipped, all of which aggravate the condition. Nevertheless, high heels are not the only cause of bunions.

It’s quite probable that our genes are to blame for this. In 78–85% of the cases, the bunion is inherited, mostly from the mother. A very frequently encountered form of bunion is idiopathic, meaning it appears spontaneously, without any observable causes. There are also some congenital disorders that may induce the condition, such as metatarsus primus varus. Additionally, there are numerous mechanical factors (damaged ligament system, rheumatoid arthritis, second toe amputation etc.) that may result in problems with bunions.

How does(n’t) it work

The hallux valgus angle, which is the angle between the longitudinal axes of the proximal phalanx and the first metatarsal bone of the big toe, is considered abnormal if it’s greater than 15–18 degrees. Applying excessive pressure to the big toe results in stretching (and consequently, weakening) of its internal structure. This leads to many pathoanatomical and biomechanical changes in the entire foot. Pain is usually the first symptom of a bunion, which becomes fully fledged if ignored for too long.

We should recognise any recurring pain in the forefoot and limited metatarsal mobility, particularly while walking, as a red flag. The forming bunion may also rub on the inside of our shoe, resulting in abrasions, inflammations, and toe damage.

The most common ways to diagnose a bunion are X-ray, medical ultrasound, and MRI. They can help determine whether it’s still possible to employ conservative treatment or if the surgery is the only option. In the first case, the goal is to reduce the symptoms. The patient has to wear special shoes (broad tip, low heel, flexible sole), use pressure-reducing forefoot insoles and stabilising ortheses, participate in physical therapy, and so on. However, this method offers no possibility of completely eliminating the condition. As emphasised by Dr hab. Artur Gądek, head of the JU Clinic of Orthopaedics and Physical Therapy: ‘A surgery is performed if the patient is in pain. It is not performed for cosmetic reasons’.

If invasive treatment is chosen, surgeons fully reconstruct the foot. ‘There is no single standard method for every bunion surgery. A choice is made after an extensive clinical and radiological analysis, which require specialist knowledge’, adds Dr hab. Gądek. Since surgeries are performed when the bunion is in an advanced stage, they are usually very difficult and carry the risk of multiple complications. Fortunately, most patients are treated successfully and their feet are returned to their natural state.

While there are no truly effective ways of preventing the formation of a bunion, we can all ensure that our shoes fit our feet and be on the lookout for worrying changes in our bodies.

Picture at the top: Lamiot CC BY-SA
Original text: www.nauka.uj.edu.pl

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