Some people have bunions that flare outward, while the heel of the big toe closes inward, making the front foot look like a triangular “snake head”, which is called a bunion. The bunion can be located underneath the second and third toes if the bunion is severe, which can cause the second and third toes to top off and form a hammer toe over time. After the heel of the big toe (actually the first metatarsal) has moved inward, it makes the area extremely elevated and easy to form friction with shoes. This causes pain, and local ulceration can cause infection. Patients with bunion deformities have abnormal forefoot biomechanics, and many have combined calluses (hard calluses or “corns”) on the bottom of the foot. This makes walking painful, and the patient has no footwear to adapt to, bringing inconvenience and pain to work and life, and also lacking in aesthetic appearance.
How do bunions occur?
First of all, there is congenital heredity, 70% of patients have hereditary factors and most of them are inherited in the maternal line. Acquired factors include inappropriate weight bearing, standing and walking for too long, trauma, wearing stiff pointed shoes with high heels, etc., which cause force on the front of the foot when walking and squeeze the bunion to the outside, promoting and aggravating the occurrence of bunions.
Rheumatoid arthritis and rheumatoid arthritis often result in bunion deformity due to joint destruction and subluxation. As the bunion extensors, bunion flexors and bunion adductors are strained and pulled, the bunion rotates forward along its long axis and turns the nail outward toward the midline and continues to worsen, the medial head of the bunion extensors and bunion flexors and their medial seed bone shift outward and lose their abduction role, and then the lateral head of the bunion adductors and bunion flexors contract, the lateral joint capsule contracts and thickens, the bunion is semi-dislocated outward, the peroneal seed bone moves between the first and second metatarsal heads, and the bunion pushes the first metatarsal head outward. The bunion is exotropic and pushes the first metatarsal inward, widening the transverse arch of the foot to the point where the medial metatarsal head is squeezed and rubbed by the upper of the shoe, resulting in bunions and pain, and then the first metatarsal head becomes larger to form a medially protruding bone.
As a result of strain on the thumb muscle, the transverse arch of the foot flattens, the second and third metatarsal heads collapse to the metatarsal side, weight bearing and friction cause the skin there to thicken and form a callus, the bunion turns outward, squeezing the second toe, occupying the position of the second toe, lifting the second toe and overlapping 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 third toe, and the dorsal side of the interphalangeal joint is rubbed and squeezed by the upper of the shoe, resulting in a callus. The dorsal side of the interphalangeal joint is rubbed and squeezed by the surface of the shoe, resulting in callus pain.
The bunion joint is in a semi-dislocated position and gradually develops osteoarthrosis under prolonged abnormal stress, resulting in destruction of joint cartilage, osteophytes, narrowing of joint space and more pain.
How can bunions be treated?
Surgery is still a major treatment for bunions, and there are more than 200 surgical methods:
① Proximal phalangeal osteotomy;
②Basal osteotomy of the first metatarsal bone;
③Osteotomy of the first metatarsal cadre;
④Osteotomy of the neck or head of the first metatarsal bone;
(5) First cuneiform osteotomy.
What should I do if I have a painful hammertoe or plantar callus?
Patients with bunions, especially those with moderate or severe bunions, have painful calluses due to the bunion turning outward, squeezing other toes, lifting the second and third toes (especially the second toe), overlapping with the bunion, causing the metatarsophalangeal joint to overreach and the proximal interphalangeal joint to flex, becoming a hammer toe, and the dorsal side of the toe joint being rubbed and squeezed by the shoe surface, generally speaking, those with bunion angles over 35° have different degrees of hammer toe deformity, due to the second metatarsal toe subluxation The second metatarsal head is pressed down and the metatarsal head touches the ground before the other metatarsal heads, plus the second and third metatarsal trunks have less dorsal extension than the fourth and fifth metatarsal trunks due to the limitation of the metatarsal cuneiform joint, which increases the weight of the second metatarsal head and forms a painful callus under the metatarsal head. Hammertoe is a complicating deformity of the bunion and is more prevalent in the second and third toes.
In the treatment of severe bunions combined with hammertoe deformity, a small incision is used to perform interphalangeal arthroplasty and, depending on the patient’s symptoms, an osteotomy and elevation of the second, third, and fourth metatarsal heads is performed accordingly. However, in many patients with mild hammertoe, the hammertoe and corpus callosum can disappear with postoperative exercises.
How can bunions be prevented?
The prevention of bunions is very important. For patients with early or mild bunions, bunion braces can be used to help reduce symptoms.
In addition, for post-operative patients or those with mild bunions, it is better to choose shoes with a flat and wide toe, and the heel should not be too high. For early lesions with mild pain, non-surgical treatments can be used, including massage, moving the bunion to the inside of the foot, walking barefoot on sandy ground, exercising the foot muscle, applying heat and resting, etc. The rubber band on the first toe on both sides is used for traction in the opposite direction, four times a day for 5-10 minutes each time. -10 minutes. Or put rubber strips on all toes, toes do separation action.
If the patient also suffers from corpus callosum, flatfoot or heel pain, a metatarsal pad, flatfoot pad or heel pad can also be used.