Ever wonder why the big toe joint is so achy? Does it feel stiff, sore, or swollen? Your big toe joint can go through a lot of abuse over years. It gets stubbed, jammed, and squeezed into shoes. All of this microtrauma can lead to long term damage. Who would have thought your big toe could be such a pain.
Hallux is another name for you big toe. Like any joint, your hallux joint consists of two bones with a layer of cartilage on both ends. The cartilage provides for a sleeker surface and absorbs shock to protect the bones from damage. When one suffers from arthritis it is due to a breakdown or damage to the cartilage that causes the bone to run up against bone. This rough friction causes swelling and pain.
Over the years your big toe joint can suffer damage from simple accidents like stubbing your toe in the middle of the right, dropping an object on your toe, and so many other things. Eventually, the cartilage gets damaged and is slowly destroyed. The first symptom of this destruction is limited joint motion. When we walk, our big toe joint should have about 65 degrees of motion. With joint damage, the amount of motion gets smaller and smaller and BAM! The pain hits you out of nowhere! All of a sudden you notice your big toe is stiff or rigid and oh so painful.
Hallux Limitus refers to a decrease in big toe joint motion and Hallux Rigidus is when there is complete loss of big toe joint movement. The early symptoms of hallux limitus consist of pain and stiffness in the joint when walking, standing, and especially squatting. There may be an increase in pain in colder temperatures and damp weather. There is often swelling at the joint. Over time the jamming of bone up against one another can cause new bone formation that forms a bump on the top of your joint. This bump is called a bone spur. This will cause the joint to be more painful and it will eventually lose complete motion or become rigid.
Patients often confuse this disease with a bunion because they both form a bump by the big toe. Though a bunion is also very painful, it is a completely different problem. Bunions are formed when your bones get displaced off to the side. Thus, the bump is on the inside of your foot. With hallux Limitus and Rigidus, the bump is on top.
The treatment for Hallux Limitus/Rigidus depends on how far along the disease has progressed. At early stages, it is important to promote motion at the joint. The more the joint is exercised, the better the outcome will be. This can be customized with orthotics and physical therapy. In cases of a more severe hallux limitus, surgery might be needed to remove the bump or sometimes the joint is replaced with a metallic joint implant. If the disease progresses to Hallux Rigidus, the therapy is surrounded around minimizing joint movement to decrease the pain. This can often be done with orthotics, but in most cases surgery is necessary.
Sometimes, the lack of motion at the big toe joint is asymptomatic. However, the person’s gait is altered and is suffering from knee or lower back pain or even pain on the outside of the foot. When you can’t push off with the big toe joint, you will need to apply more pressure on the outside of that foot. This can lead to pain in other areas of the body.
So, if you are suffering from pain along the big toe joint, do not hesitate to see a podiatrist. In the early stages of these deformities, surgery can possibly be prevented. If you are having back or knee pain, make sure your doctor checks your feet. Remember, if the ground floor is broken, then the other floors will crumble as well.
Wednesday, October 21, 2009
Saturday, September 26, 2009
Bunions at the Dinner Table
Victoria Beckham, also known as Posh Spice, has made the news several times this year. Not because of her husband’s amazing talents or her singing career, but rather because of her feet. This Spice Girl has a very serious dilemma. Should she correct her bunions or should she continue to wear sexy shoes and deal with the pain?
A bunion deformity is when your big toe tilts toward your small toes. Over time, the big toe creeps further and further along and causes a bump to protrude out on the side of your foot. This bump is actually the bones that make up the joint at your big toe. There is not one thing that causes bunions. Simply wearing high heels will not lead to bunions though they may make the bunion worse. The most common factor linked to bunions is hypermobility of a joint in the mid-section of your foot.
Hypermobility does not mean flexibility but rather movement when there is not suppose to be movement. Think of a table with four legs but one leg is a little off. The table is designed to be stable, but a tiny flaw causes it to tilt when you apply pressure to the surface. If you place some support such as a pack of napkins under the disabled leg, the table is no longer hypermobile. Detecting hypermobility in the foot is not as easy to notice as an uneven dinner table, but with careful examination, podiatric physicians are able to detect this problem that is often associated with bunions.
When treating bunions, the initial approach is conservative therapy of orthotics, padding, and strapping. These treatments are similar to the concept of putting the napkins under the unsteady table to make it less hypermobile. But, at some point the bunion gets to the point where surgical correction is necessary. Just as there is probably a dozen ways to take the unstable table to the shop and make it functional, there a dozen ways to correct a bunion. The skill of the surgeon is to determine what procedure is best to prevent the problem from reoccurring. To do this, the surgeon must identify the root of the problem. As we mentioned before, hypermobility is the most likely cause for most bunions.
Lets go back to the table example. If we wanted to correct our unsteady table, is it best to saw the other three legs down, or figure out why the one leg is shorter and try to correct the site where the problem exists. The reason that so many patients and doctors have trouble treating a bunion at its root is because of the crucial recovery time. A Lapidus procedure is the most reliable technique to correct bunions due to hypermobility. This procedure fuses, or unites, the two bones at the location of the hypermobility, which is along the midfoot region. The doctor could do the procedure and have a perfect operative result, but the most important part of the treatment is the patient’s ability to stay off their foot! After surgery, a patient has to be put in a cumbersome cast and is unable to bear weight on their foot for six weeks. With all bunion surgeries, the patient must exercise the big toe joint to ensure proper motion. Some recovery time may be spent with a physical therapist to assist in strength training your foot back into action.
It is essential that bunion treatments are done correctly the first time.
When the focus is on the cause of the problem and not how to immediately improve appearance, the patient will be much more pleased with the surgical results in the long run. If you are serious about getting your bunions corrected, then you must also take the doctor’s post-operative instructions serious. I wonder if this is what is holding Victoria Beckham back from getting her bunion fixed. This “A” list celebrity would rather run around in excruciating pain in an unsightly bunion to please all the Spice Girl fans. Back here in the real world, you can run around with your children or girlfriend’ pain free and bunion free if you take the time to treat it right!
A bunion deformity is when your big toe tilts toward your small toes. Over time, the big toe creeps further and further along and causes a bump to protrude out on the side of your foot. This bump is actually the bones that make up the joint at your big toe. There is not one thing that causes bunions. Simply wearing high heels will not lead to bunions though they may make the bunion worse. The most common factor linked to bunions is hypermobility of a joint in the mid-section of your foot.
Hypermobility does not mean flexibility but rather movement when there is not suppose to be movement. Think of a table with four legs but one leg is a little off. The table is designed to be stable, but a tiny flaw causes it to tilt when you apply pressure to the surface. If you place some support such as a pack of napkins under the disabled leg, the table is no longer hypermobile. Detecting hypermobility in the foot is not as easy to notice as an uneven dinner table, but with careful examination, podiatric physicians are able to detect this problem that is often associated with bunions.
When treating bunions, the initial approach is conservative therapy of orthotics, padding, and strapping. These treatments are similar to the concept of putting the napkins under the unsteady table to make it less hypermobile. But, at some point the bunion gets to the point where surgical correction is necessary. Just as there is probably a dozen ways to take the unstable table to the shop and make it functional, there a dozen ways to correct a bunion. The skill of the surgeon is to determine what procedure is best to prevent the problem from reoccurring. To do this, the surgeon must identify the root of the problem. As we mentioned before, hypermobility is the most likely cause for most bunions.
Lets go back to the table example. If we wanted to correct our unsteady table, is it best to saw the other three legs down, or figure out why the one leg is shorter and try to correct the site where the problem exists. The reason that so many patients and doctors have trouble treating a bunion at its root is because of the crucial recovery time. A Lapidus procedure is the most reliable technique to correct bunions due to hypermobility. This procedure fuses, or unites, the two bones at the location of the hypermobility, which is along the midfoot region. The doctor could do the procedure and have a perfect operative result, but the most important part of the treatment is the patient’s ability to stay off their foot! After surgery, a patient has to be put in a cumbersome cast and is unable to bear weight on their foot for six weeks. With all bunion surgeries, the patient must exercise the big toe joint to ensure proper motion. Some recovery time may be spent with a physical therapist to assist in strength training your foot back into action.
It is essential that bunion treatments are done correctly the first time.
When the focus is on the cause of the problem and not how to immediately improve appearance, the patient will be much more pleased with the surgical results in the long run. If you are serious about getting your bunions corrected, then you must also take the doctor’s post-operative instructions serious. I wonder if this is what is holding Victoria Beckham back from getting her bunion fixed. This “A” list celebrity would rather run around in excruciating pain in an unsightly bunion to please all the Spice Girl fans. Back here in the real world, you can run around with your children or girlfriend’ pain free and bunion free if you take the time to treat it right!
Wednesday, January 14, 2009
Bunions: Should I have Surgery?
A bunion or hallux valgus is a foot deformity that causes your big toe to tilt inward. This causes an enlargement of the metatarso-phalangeal joint, the joint where the big toe meets the foot. This deformity can be seen as a bump on the outside edge of your foot at the base of the big toe. The subluxation of the joint, compromises the joint’s normal function. Since the joint is important in ambulation and takes on a considerable amount of weight and stress, the deformation can cause pain. There is much debate about whether shoes alone can lead to bunions or if there is a genetic predisposition. Bunions are much more common in societies that wear shoes, but since bunions do show up in societies that remain barefoot, we can conclude that shoes are not the principle or only factor that causes the deformity.
Surgery has been shown to be the best treatment for bunions. It has the highest rate of patient satisfaction and over long periods of time, it has the lowest rate of pain, cosmetic disturbances and footwear issues. Like all surgeries, there is risk of complications during or after the procedure. This risk is very low. So why don’t we rush everyone to the operating room? Not everyone is a surgical candidate. Elder patients and patients with some other medical conditions have an increased risk of surgical complications, and therefore are not advised to go under the knife. Podiatric surgeons do not find cosmetic appearances justifiable for surgery. Though the risk is small for complications, it is best to avoid surgery if it is not necessary. A podiatric physician may consider surgery for you if the deformity is causing you pain and interfering with your life, shoe gear can no longer accommodate your deformity, or conservative treatments have failed to relieve you of your pain.
It is best to always start with conservative treatments. If these treatments do not work then the podiatric physician will explore more invasive modalities such as surgery. Since a bunion is a problem in joint subluxation (moving out of place), it is impossible to completely correct the deformity without surgery , but the progression of the deformity and pain caused by the deformity can be greatly reduced by other means.
Orthotics are the wonder treatment in podiatric medicine. Since so many foot problems are due to biomechanical mishaps in the foot, orthotics are necessary to regain proper function of the foot and ankle. Podiatric physicians are also trained to accommodate orthotics to the patient’s specific deformity or functional problem.
Padding is a very easy and cheap way to address bunion pain. Podiatrists are trained in padding techniques that may be applied directly to your foot or placed in your shoe to help relieve the pressure on your bunion.
Proper shoe gear is always very important. Getting out of heals and wearing shoes with a wider toe box can greatly relieve pain and slow the progression of the deformity. Weather you have surgery or not, you have to say goodbye to pointy toes and high heels.
Night splints have also shown to reduce pain and progression. Few studies have measured the success of the devices in adults, but they have shown to be very beneficial in adolescents. There are many generic devices that can be bought over the counter, but it is best to speak to your podiatric physician before using such device. They may cause irritation and people with diabetes should be especially cautious when using any over-the-counter product.
Though surgery has many successful outcomes, it is still a serious commitment and needs to be well thought through. It is important to have good communication with your doctor about your worries and concerns. Surgery should be a last resort treatment for you and your doctor. Conservative treatment is less expensive, less invasive, and less risky. Since conservative treatment is not correcting the underlying problem, it does not work for everyone. Thus, if non-invasive treatment has not relieved your pain, you and your doctor may need to consider surgery.
Surgery has been shown to be the best treatment for bunions. It has the highest rate of patient satisfaction and over long periods of time, it has the lowest rate of pain, cosmetic disturbances and footwear issues. Like all surgeries, there is risk of complications during or after the procedure. This risk is very low. So why don’t we rush everyone to the operating room? Not everyone is a surgical candidate. Elder patients and patients with some other medical conditions have an increased risk of surgical complications, and therefore are not advised to go under the knife. Podiatric surgeons do not find cosmetic appearances justifiable for surgery. Though the risk is small for complications, it is best to avoid surgery if it is not necessary. A podiatric physician may consider surgery for you if the deformity is causing you pain and interfering with your life, shoe gear can no longer accommodate your deformity, or conservative treatments have failed to relieve you of your pain.
It is best to always start with conservative treatments. If these treatments do not work then the podiatric physician will explore more invasive modalities such as surgery. Since a bunion is a problem in joint subluxation (moving out of place), it is impossible to completely correct the deformity without surgery , but the progression of the deformity and pain caused by the deformity can be greatly reduced by other means.
Orthotics are the wonder treatment in podiatric medicine. Since so many foot problems are due to biomechanical mishaps in the foot, orthotics are necessary to regain proper function of the foot and ankle. Podiatric physicians are also trained to accommodate orthotics to the patient’s specific deformity or functional problem.
Padding is a very easy and cheap way to address bunion pain. Podiatrists are trained in padding techniques that may be applied directly to your foot or placed in your shoe to help relieve the pressure on your bunion.
Proper shoe gear is always very important. Getting out of heals and wearing shoes with a wider toe box can greatly relieve pain and slow the progression of the deformity. Weather you have surgery or not, you have to say goodbye to pointy toes and high heels.
Night splints have also shown to reduce pain and progression. Few studies have measured the success of the devices in adults, but they have shown to be very beneficial in adolescents. There are many generic devices that can be bought over the counter, but it is best to speak to your podiatric physician before using such device. They may cause irritation and people with diabetes should be especially cautious when using any over-the-counter product.
Though surgery has many successful outcomes, it is still a serious commitment and needs to be well thought through. It is important to have good communication with your doctor about your worries and concerns. Surgery should be a last resort treatment for you and your doctor. Conservative treatment is less expensive, less invasive, and less risky. Since conservative treatment is not correcting the underlying problem, it does not work for everyone. Thus, if non-invasive treatment has not relieved your pain, you and your doctor may need to consider surgery.