Bunion is a foot deformity in which the bunion is deflected outward beyond the normal physiological angle. It is manifested as a flared bunion (>15°) with an inflated medial projection (bony formation), a triangular or fan-shaped change in the entire foot, and a bunion at the medial bone projection due to friction with the shoe. Severe cases can produce painful calluses (calluses) with thickening on the bottom of the foot, and other toes other than the bunion are deformed one after another, with painful friction between toes or on the toe surface.
Unlike most orthopedic diseases, which mostly have a clear cause and time, bunions always come quietly. Originally beautiful toes, do not know when to start, slowly began to change, and, more and more serious. It becomes difficult to buy and wear shoes; fixed or wandering pain, making it difficult to lift.
In our country, many places have different common names for bunions: big foot bone, big bone abduction, etc., which means that people have long known that it is an abnormality. However, why was little attention paid to it in the past and why was little medical attention sought? There are many reasons for this: bunions are hereditary, and many people in the family are used to having bunions; in the past, people’s range of activities were more limited, and they endured less activities because of foot pain; obviously it was painful, and they wanted to treat it, but they gave up because of economic pressure.
Now, with the improvement of living standard and economic level, the popularity of social activities and leisure activities, a pair of healthy feet is extraordinarily important, and patients are eager to know more about bunions and hope to get professional guidance and treatment.
It is true that 50-80% of bunions are born with the condition, which is one of its causes, hereditary. But it is not true that you are born with bunions, on the contrary, the bunions of newborn children are even somewhat turned inward, so how do they grow into bunions later, with an incidence of 20% or more of the female population (the incidence of women is 2-5 times higher than that of men)? This is because the structure of the human body is complex, and any kind of structural congenital defect will manifest itself later in growth or during life, forming a variety of diseases.
This is the case with bunions, where there are abnormalities in the development of the metatarsal bones and joints. Another cause is the wearing of shoes. Wearing narrow and high-heeled shoes makes the shape and weight-bearing point of the foot become abnormal (the weight-bearing point of the first metatarsal head increases five times), the tendon axis is shifted, and the ligaments are out of balance, leading to deformation. The earlier the age of wearing high heels, the greater the impact. Others, such as trauma, neuropathy, and joint pathology, may cause bunion deformity.
Bunion is a complex disease with at least 10 variations from pathological analysis:.
1, bunion of the toe.
2. Bone redundancy and bunion.
3, Contracture of the lateral structures.
4.Inner rotation of the first metatarsal.
5.Deviation of the joint surface.
6.External rotation of the bunion.
7.Interphalangeal bunion.
8.Irregularity of the first metatarsal cuneiform joint.
9.Metatarsophalangeal joint osteoarthrosis.
10.Complicated deformities and lesions of bunion: dermatomal neuritis of the bunion, soft corns between the toes, plantar callus and plantar pain, bony formation of the little toe, secondary deformities of the 2nd-5th toes, etc. For each patient, there may be different presentations and different problems to be addressed.
So, how does the doctor make decisions when faced with such a complex lesion? The first step is a meticulous inquiry. In addition to understanding the cause and course of the disease, the patient’s occupation, lifestyle habits, and expectations of treatment are the basis for the doctor’s decision. Next, a thorough examination is done, not only of the bunion, but also of the entire lower extremity, spine, and, if necessary, vascular and neurological function tests.
Weight-bearing standard front and side x-rays are necessary, and sometimes oblique films and axial films of the seed bone are taken, followed by precise measurements of the x-ray foot image. Based on the examination and x-ray measurements, the doctor will usually make a determination of the degree of the bunion, which is usually classified as mild, moderate or severe, and there are also different ways to classify it. Based on the classification, treatment options are chosen.
Almost all patients, at the first visit, are most concerned about whether the treatment can be done without surgery. It can be done without surgery, however, the results are often poor and may delay, but not stop, the progression of the deformity, much less cure it. Surgery is an effective and reliable way to treat bunions.
In fact, bunions were already being studied in the West 100 years ago, when we were still wrapping girls’ feet and turning them into “three-inch golden lotuses”. They invented many surgical methods to return this deformed toe to its original shape and to relieve the pain caused by the deformed toe. Some of the more representative ones were Heuter’s partial resection of the metatarsal head in 1871 and Keller’s partial resection of the proximal phalanx of the bunion in 1904, which gradually evolved into the current bunion-metatarsophalangeal joint replacement surgery;
Sliver’s bony resection capsulotomy in 1923 and McBride’s soft tissue release capsulotomy in 1928 have become the basic steps in almost all bunion surgeries; Hohmann’s subtalar head external osteotomy in 1921 and Wilson’s oblique external osteotomy of the metatarsal neck in 1963 are the basis of the present minimally invasive osteotomy.
Generally speaking, bunion surgery is divided into several broad modalities.
1, Soft tissue surgery: suitable for mild bunions, and in most cases used in combination with other surgeries.
2, Osteotomy orthopedic surgery: suitable for most bunion patients with good joint function.
3.Arthroplasty surgery: suitable for elderly bunion patients with joint lesions.
4.Joint fusion surgery: suitable for younger bunion patients with joint lesions and patients with instability of the metatarsophalangeal joint.
5.Arthroplasty: suitable for bunion patients with joint lesions. The surgeon will choose the surgical method according to the condition, which can be a single method or may require a combination of several modalities, which is individualized treatment.
Surgery is only the first step in bunion treatment; rehabilitation exercises after surgery are crucial. The surgeon will tell the patient the method of rehabilitation, but the implementation depends mainly on the patient himself, which requires some perseverance and patience. The success of surgery is a combination of the correct surgical approach, precise surgical operation, and standardized rehabilitation exercises.