Health Care

By Dr Marybeth Crane

It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn't stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, they assumed any pain in the great toe accompanied by a bump was a "bunion" or Hallux Abducto Valgus. Unfortunately in this case, her doctor was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. If she had sought treatment many years ago, her joint may have been salvaged. Now her joint was so destroyed that she needed a joint replacement or fusion. Not what she wanted to hear! In her mind, she came in the office asking for a simple bunionectomy and left needing a joint replacement. She regretted not seeking the advice of a podiatrist earlier.

So what's the difference between Hallux valgus and Hallux limitis?

Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.

Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.

Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don't ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!

Why is treatment of Hallux limitis so important in the early stages? Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.

The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.

The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can't stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don't delay. See your podiatrist today!

Dr Marybeth Crane is a board certified podiatric foot and ankle surgeon specializing in sports medicine. Your feet should last a lifetime! For more foot health tips, a copy of her new book "If Your Running Feet Could Talk" and doctor-approved foot care products, visit her website or read her blog. Your body will thank you for it!

Article Source: http://EzineArticles.com/?expert=Dr_Marybeth_Crane

A bunion ( hallux valgus ) is a sometimes painful structural deformity of the bones and the joint between the foot and big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The normal position of the big toe (straight forward) becomes outward-directed toward the smaller toes. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint) can become inflamed with redness, tenderness, and pain . A small fluid-filled sac ( bursa ) adjacent to the joint can also become inflamed ( bursitis ) leading to additional swelling, redness, and pain. Bunions can occur for a number of reasons, but a common cause is wearing shoes that fit too tightly. They can also develop as a result of inherited structural defect, injury, stress on your foot or another medical condition. Often, treatment involves conservative steps that may include changing your shoes, padding your bunion and wearing shoe inserts. Severe cases of bunions may require surgery to relieve the pain. Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe. The discomfort commonly causes a patient to walk improperly. Another type of bunion which some individuals experience is called a Tailor's Bunion, also known as a Bunionette. This forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.

A bunion is one problem that can develop due to hallux valgus, a foot deformity. The term "hallux valgus" is Latin and means a turning outward (valgus) of the big toe (hallux). Bunions result from inflammation and thickening of the bursa (fluid-filled sac in the connective tissue) and cause abnormal bone formation and misalignment of the toe. Bunions can be related to inflammation or to degenerative disease (e.g., osteoarthritis). They cause redness, tenderness, and pain, and alter the normal position of the first toe. "Hallux abductovalgus" (HAV) is a term that refers to the hallux going away (abducting) from the midline of the body and twisting so the inside edge touches the ground and the outside edge turns upward. Essentially, this term describes the deviation of the toe toward the outside of the foot. Bunions worsen over time and cause discomfort, difficulty walking, and skin problems such as corns and lesions.

Causes of Bunions

1. Family history of bunions.

2. In some cases, bunions can occur due to trauma or injury to the feet.

3. Rheumatoid or osteoarthritis.

4. Genetic and neuromuscular diseases which can result in a muscular imbalance such as Down's syndrome.

5. If one leg is longer then the other, the longer leg is more inclined to develop a bunion.

6. The most important causative factor is poor fitting footwear. This accounts for an higher incidence among women then men.

Symptoms of Bunions

1. A bulging bump on the outside of the base of your big toe.

2. Pain or soreness.

3. Thickening of the skin at the base of your big toe.

4. Restricted movement of your big toe.

5. Persistent or intermittent pain.

6. A burning sensation

Treatment of Bunions

1. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain.

2. Injection therapy. Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions.

3. Applying an ice pack several times a day helps reduce inflammation and pain.

4. Avoid activity that causes bunion pain, including standing for long periods of time.

5. Avoid high heeled shoes.

6. Apply a commercial bunion pad, making sure it is not too rigid or medicated.

7. A Bunion Shield can reduce the pain over the bunion.

8. Apply a moisturizer such as flexitol heel balm twice daily to hard skin or corns and use a pumice stone to reduce the thickness of the hard skin.

A bunion ( hallux valgus ) is a sometimes painful structural deformity of the bones and the joint between the foot and big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe.

Juliet Cohen writes articles for online medical clinic and diseases treatment. She also writes articles on skin disorders.

Article Source: http://www.eArticlesOnline.com