1, bunion is a common disease, so what kind of disease is a bunion?
A bunion is a bunion where the big toe flares outward and the root closes inward, resulting in a large bulge at the root, making the front foot look like a triangular “big snake head”, which is a bunion (commonly known as “goblet crutch, big foot chronic”). If left untreated, the deformity and pain will gradually worsen, seriously affecting the position of other toes and joints, and also easily lead to calluses on the bottom of the foot. The bunion turns outward, squeezes the second toe, occupies the position of the second toe, lifts the second toe and overlaps the bunion, causing the metatarsophalangeal joint of the second toe to overstretch and the interphalangeal joint to flex, becoming a hammer toe, protruding from the dorsal side of the bunion and the third toe, and the dorsal side of the interphalangeal joint is rubbed and squeezed by the shoe surface, also producing callus pain. As the lesion develops, the cartilage of the big toe joint is destroyed, the bone is enlarged, the joint space becomes narrower, and it becomes more painful. Bunions are usually discovered by the patients themselves, and their symptoms are at most painful as bunions. In a normal person, the long axis of the bunion forms a sharp angle with the long axis of the metatarsals, and this angle is about 15°. There is also an inversion between the first and second metatarsals within 9°. A bunion can only be diagnosed if the bunion tilts more than the angle as above and is combined with bunion pain.
2.What are the dangers of bunions?
① Pain is the main symptom. The pain mainly comes from the inner side of the first metatarsal head, and the pain increases when walking. The bunion flares outward, and then the bone at the root of the bunion protrudes. After protruding, this bone protrudes when you wear shoes and rubs the upper of the shoe, and after a long time, it can cause inflammation and pain in this area, which is called bunion in our medical science, and local ulceration can cause infection. If the bunion is prolonged, the second toe can also be raised up, forming a kind of droopy toe, and if the droopy toe is serious, it can cause pain in the back of the bunion (the “corns”), because the bunion can cause the collapse of the transverse arch under the sole of the foot, resulting in increased force on the second and third toes and reduced force on the bunion. The deformity of the bunion is not proportional to the pain. Some deformities are obvious, but the pain is not very obvious. It hurts badly when you walk more. ② It is very difficult to wear shoes, and it is impossible to find suitable shoes to wear. It is especially difficult for these people to buy a pair of suitable shoes. ③The appearance is unattractive, the root of the big toe bulges out a section than others. ④Psychological impact. Many patients are troubled by bunion disease for a long time and cannot participate in social activities, and even have difficulty walking, which brings great inconvenience to life. However, after the bunion is treated, the patient is able to be active in social places again. Bunion treatment has an important significance in improving people’s quality of life and protecting the workforce.
3. What is the incidence of bunions?
Bunions are a common foot condition. The incidence rate of women is 20%. The incidence of bunions in foreign countries is 50%, but there are also certain genetic factors and acquired factors, generally adolescence and middle-aged and elderly people (after 40 years old) are prone to develop, especially around 45 years old female patients, bunions and age is also proportional, the older the age, the heavier the deformity. In recent years, the number of women wearing high-heeled shoes has increased, and the incidence is on the rise. The incidence is higher in foreign countries than in China, and the incidence is higher in the northern part of China than in the south, which is related to the habit of wearing high-heeled shoes and pointed shoes. Long-term standing workers, such as teachers, nurses, salesmen, hairdressers, etc., have a significantly higher incidence.
4. Why do bunions occur?
The causes of bunions are not yet clear, but the causes are: 1, genetic factors (80% of them are hereditary, 70% of which are inherited from the mother’s line); 2, wearing inappropriate pointed shoes, high heels; 3, long-term inappropriate weight bearing, standing and walking for too long; 4, suffering from other diseases, such as rheumatoid and rheumatoid arthritis often due to joint destruction to form a subluxation, bunion deformity. Flat feet (commonly known as flat feet), the 1st metatarsal is too long, too short, etc.
5.How is it treated?
It includes non-surgical treatment and surgical treatment. Non-surgical treatment can be used for mild ectropion and mild pain, and surgical treatment can be used if the deformity and pain are severe. The most effective treatment for bunion is surgical treatment. There are more than 200 surgical methods, and which method of treatment is used should vary from person to person. Currently, there is no single surgical method that can “cure all”. Surgical methods include: soft tissue surgery, osteotomy, combination of both, artificial joint replacement, arthroplasty, and joint fusion. It is important to choose the treatment method according to the condition, and it is not scientific to treat all patients with the same surgical method. Each type of surgery has its own characteristics, and the excellent rate of surgery is about 70% to 90%. The treatment of bunions is an unsolved problem in the orthopaedic community, and no treatment can guarantee non-recurrence. Therefore, everyone is studying ways to reduce recurrence, and we have proposed a new staging method for bunions together with Huashan Hospital of Fudan University to help choose the surgical approach. It has been adopted by the Foot and Ankle Surgery Group of the Chinese Orthopaedic Association and will be included in the “Clinical Guidelines for Clinicians” of the Ministry of Health. The “transverse arch reconstruction method for the treatment of bunions” that we have created has advanced bunion surgery from two-dimensional to three-dimensional orthopedics, from local deformity correction to comprehensive correction, from empirical and qualitative typing to systematic and quantitative typing, improving the efficacy and reducing the complications of surgery. Another trend that has gradually gained popularity in recent years is the small incision osteotomy for bunion treatment. Small incision osteotomy surgery for bunion has the characteristics of small injury, small incision, no cast, no steel pin, fast healing, less pain, and the ability to move on the ground after surgery. We are studying micro-hole surgery to treat bunions, which has a smaller surgical incision.
6.What degree of bunion needs surgery?
In the past, the purpose of treating bunion is to relieve the pain, and surgery should be performed when it affects the walking and pain, but not for painless or painful deformities. And with the improvement of people’s living standard. Some patients, mainly young female patients, visit the clinic mainly for the purpose of not being able to wear fashionable shoes due to their unattractive appearance; or due to the need to wear high heels in certain arenas, but they are too painful to wear them. About 20% of bunion patients come to the clinic with the primary cause of their foot aesthetics, rather than pain or functional limitations. More than 70 percent of patients express a clear desire for treatment to eliminate the “goblet foot” that has been with them for years. This request is especially common among young, white-collar women.
7. Can bunion surgery completely restore normalcy?
Yes.
8.Can elderly people have the surgery?
Elderly people request surgery because they have unbearable pain and cannot wear shoes. If the cardiopulmonary function is good and there is no systemic infection, this surgery can be performed. We have operated on male patients in their 70s.
9.The bunion is not heavy, but the callus under the sole of the foot is very heavy and it hurts a lot to walk, can it be treated?
Surgery can be performed, but if it is mild it can also be treated conservatively, such as with foot pads. Since bunions can cause the arch to collapse and flatten, the first metatarsal head corresponding to the bunion is elevated, and the second and third metatarsal heads corresponding to the second and third toes are overloaded and abraded causing the skin there to thicken and form calluses (calluses). In such cases, the osteotomy method should be used for three-dimensional correction, which requires rotation, depression and nudging, which is our first “transverse arch reconstruction method” for bunion treatment in China.
11.What is the best age for bunion surgery?
If you want to have bony surgery, you have to do it after the epiphysis of the child closes (after 16-18 years old).
12.The bunion deformity is not very serious, can it be done without surgery? If so, how can it be treated?
Mild bunions can be treated without surgery by massage, moving the bunions to the inside of the foot, such as tying a comfortable rubber band between the two bunions and making traction movements in the opposite direction of the left and right, 4 times a day for 5-10 minutes each time. Or put the rubber band on all the toes and do the toe separation action. If bunions occur, you can do physical therapy, hot compresses, and wear loose shoes to avoid compression of the foot. You can also use cotton rolls to pad up between the first and second bunions or tie a splint on the inside of the foot at night to straighten the bunions. At the same time walking barefoot on sand, you can also exercise to grasp things with your toes, exercise the foot muscles or wear orthopedic shoes, flat foot insoles to correct flat feet.
13.Will the bunion get worse if it is not treated? What should I pay attention to?
The degree of deformity is proportional to the age, and the older the age, the more serious the deformity. Exercises can be carried out, and attention should be paid to the choice of shoes to avoid wearing high heels, pointed shoes and shoes with hard materials. Among women with bunions, 80% of them wore high heels or pointed shoes when they were young, so it can be said that the higher the heel and the more pointed the toe, the greater the chance of having a bunion.
14.Can dancers continue their dancing career after bunion surgery?
Yes, it should be possible.
15.What about bunions caused by severe rheumatoid arthritis?
Our department currently uses excisional molding or artificial bunion replacement for patients with severe rheumatoid foot, so that many patients who cannot walk due to foot disorders can stand up again and go to a new life.
16.How can bunions be prevented?
Bunion is a common disease, and it is important to prevent or avoid its aggravation. Prevention is mainly: 1. When choosing leather shoes, make sure to choose a comfortable style according to your foot shape. The upper should not be too hard, the heel should not be too high, and the toe should not be too pointed. Try to use shoes with a wider front and no high heel. Especially when playing sports or traveling. If you have to wear high heels for certain jobs or occasions, change them immediately after you get home and often soak your feet in hot water to relieve soft tissue spasms. 2. For lighter bunions, put rubber bands on both sides of the bunions and tug on each other left and right. Do this once or twice a day for 5 minutes each time. 3. In childhood, shoes that become smaller should be replaced at all times, the upper should not be too hard and the front of the shoe should not be too narrow. Children should not wear high-heeled shoes. Adolescents in the growth period, feet are constantly developing and growing, more unsuitable for wearing narrow pointed shoes.4.If the patient also suffers from corpus callosum, flatfoot or heel pain, etc., metatarsal pads, flatfoot pads or heel pads can also be used at the same time. Flatfoot syndrome should be prevented and treated.
17.Why do pointed leather shoes cause bunions?
Pointed shoes can cause bunions. Due to the pointed toe of the shoe, the width of the toe cannot be accommodated normally, and due to the pressure of the upper, the thumb has to be displaced inward, while the heel of the thumb is squeezed outward, thus forming a “bunion”. Severe “bunions” can cause bunions due to friction between the root of the bunion and the shoe top. Wearing high heels with a pointed toe can be even more harmful. The foot is the second heart of the body, once the toes are squeezed by the narrow toe, blood circulation will be affected, which is not good for the health of the foot. Because the front of the pointed shoes are triangular, high heeled when standing to force the front of the foot strong plug into a narrow triangular area, coupled with the upper for leather, no flexibility, bunions are forced to turn out.
19. Can wearing high heels cause bunions?
Another reason for the formation of bunions is the popularity of high-heeled shoes. before the 18th century, the French shoe style was a flat sole with a instep buckle, and there were few reported cases of bunions at that time, but since the introduction of high-heeled shoes, bunions became common in France. In Japan, people used to wear wooden clogs before the 1960s and no bunion cases were recorded. The incidence of bunions is significantly higher among flight attendants and white-collar women, which also explains the relationship between bunions and high heels. Some people have done research, when the heel of the shoe is too high, the weight of the body borne by various parts of the foot changes, the front of the foot, especially the weight of the bunion increases by five times, the ligaments of the joint relax, plus the extrusion of the sharp toe, the normal anatomical structure is changed, forming bunions. After wearing high heels, the body’s center of gravity shifts forward and the weight on the toe increases, hardening the roughly square, full front of the foot into the tapered, narrow toe, making the feet tortured and easily inducing bunions, which can even involve the lower back through a reflex mechanism, causing back pain. Therefore, it is recommended that people wear fewer high heels, and even more so for those with low back pain. In general, except for wearing high heels on specific occasions such as social and ceremonial occasions, it is still good to wear general cloth or leather shoes, with a heel not higher than 3 cm and a sloping sole. Shoes with a heel of 4-6 cm or more exceed the health care standard.
20.Why is the treatment of podiatry important?
Podiatry is a common problem today. Previously unappreciated, podiatry has become one of the diseases that affect people’s quality of life, and one out of every two people in our country suffers from podiatry. Since 1998, we have been celebrating Foot Care Week every year, each time with a different slogan to remind people: look at your feet, they are not as well protected as your face. The best way to avoid foot disease is to pay attention to your feet. Because the face has to face a lot of people and things every day, it is often very important, and the hands are the second face of a woman, which also receives a high degree of attention, while the feet, often hidden in shoes, shoes give it a shiny appearance, which itself is often neglected. Shoes are the beautiful packaging for the feet, but sometimes they are also the beautiful enemy of the feet. The fatal aspect of this dangerous relationship is that people who love beauty often pay one-sided attention to appearance. According to the survey, in a variety of foot disease is on the rise, in addition to fungal infections caused by ringworm and gray nails and other diseases caused by foot disease, many times because of improper shoe wear, excessive pedicure and other behaviors caused.
21.Can bunions be treated medically?
Generally, it cannot solve the problem, but only temporarily stop the pain.
22.Can bunions be hereditary?
Adolescent bunions often have a familial tendency to develop. If the bunion is genetic, it will develop since childhood and the symptoms will worsen with age, if it is not genetic, it is usually easy to develop after women stop menstruating. According to the research data from many scholars in Europe and the United States, there is a clear relationship between bunions and heredity. Descriptions from foreign journals of osteoarticular surgery in 1951 and 1980 showed that 63% and 68% of bunion patients had a family history in these two periods, respectively, indicating that genetics has always been a stable factor. Similar reports have been made in China, and the predominance of maternal inheritance. Obviously, children of parents with bunions should be prevented as early as possible.