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Abstract: The occurrence of bunion deformity is associated with congenital factors, with genetic factors playing a role in approximately half of the cases, especially in young people. In this paper, the patient developed congenital bunion deformity with excessive inclination of the bunion to the lateral side of the foot accompanied by local pain, which affected normal life. The congenital bunion deformity was confirmed by X-ray examination, and degenerative changes occurred in the first metatarsophalangeal joint. To relieve clinical symptoms, non-surgical treatment such as orthopedic brace was considered first, and normal walking ability was gradually restored.
Basic information】Male, 35 years old
Disease Type】Congenital bunion
Hospital】Harbin First Hospital
Date of consultation】April 2021
Treatment Plan】Conservative treatment (weight reduction, brace correction, functional exercise)
Treatment Period】7 days of hospitalization, 1 month of review
Effectiveness】 Pain relief, resumption of weight-bearing activities
I. Initial consultation
When the patient came to the hospital, he complained of bunion pain, the bunion squeezed the second toe laterally, and the pain was aggravated when walking. The patient is currently in the middle stage of the lesion and is advised to use conservative treatment to relieve clinical symptoms. If the symptom relief is limited and cannot meet daily needs, surgical treatment should be considered.
II. Treatment history
The patient developed a painful congenital bunion deformity, which affected the patient’s normal walking and also limited the patient’s motor ability. To relieve the clinical symptoms, the patient was recommended to be hospitalized for conservative treatment. Because direct surgical treatment would have caused local side effects that would have not only affected the patient’s recovery but also might have led to the loss of the patient’s chance for successful conservative treatment.
Therefore, during the hospitalization period, the patient is advised to rest, reduce weight bearing, and apply hot water bags locally with hot compresses 6-8 times a day. A rubber band was placed over the bunion to do pulling movements in the opposite direction for 5-10 minutes twice a day to strengthen the tendons around the bunion. Active use of toe grip to exercise plantar muscles, walking barefoot on sandy soil to enhance muscle balance, and using orthopedic braces for continuous correction at night while sleeping.
III. Treatment effect
After comprehensive conservative treatment with various methods, the patient’s congenital bunion deformity was significantly improved, the painful symptoms of the first metatarsophalangeal joint were reduced, the lateral tilt of the bunion was weakened, and the patient was gradually able to walk normally with weight, and was discharged after 7 days. Radiographs were taken and confirmed that the bunion deformity was partially corrected. The joint space of the first metatarsal toe was improved, the callus on the metatarsal surface of the second and third toes was eliminated, and the local pain was relieved. The athletic ability was gradually restored after wearing loose sports shoes.
IV. Precautions
This time, the congenital bunion was not treated surgically, and I still feel happy for the patient. In order to avoid aggravation of the disease, I advised the patient that after discharge from the hospital, if there is persistent pain in the first metatarsophalangeal joint and recurrence of bunion deformity and walking disorder, it is necessary to go to the orthopedic outpatient clinic for follow-up orthopedic radiographs to confirm the degree of development of congenital bunion deformity, and if necessary, surgical treatment cannot be ruled out.
In addition, patients should try to wear flat, thick-soled shoes in daily life to ensure that the forefoot is loose and avoid being squeezed, and try to prevent wearing hard-soled shoes. Foot muscle exercises need to be adhered to for a long time, and patients do not need to worry excessively after the disease arises. With active treatment, congenital bunion deformity can be prevented from continuing to worsen.
V. Personal insight
Patients with congenital bunion deformity usually need several years to develop gradually to the advanced stage. Therefore, if this patient can insist on local maintenance after this treatment to avoid continued pressure on the bunion and excessive weight bearing on the foot, the development of the lesion can be slowed down significantly to avoid prematurely entering the advanced stage.
Once the advanced stage of congenital bunion is reached, conservative treatment will not be able to meet the demand and further surgical treatment will be required, which will not only increase the local trauma and slow down the patient’s recovery, but also increase the risk of infection.