Thursday, August 19, 2010

Bunions - Hallus Abductor Valgus – Part 2

In the first stages of bunion formation, bunions are often not painful until there is a significant inward deviation of the big toe. Some of the symptoms commonly associated with bunions include localized pain near the joint (often only with palpation), redness, swelling and restricted motion.
In addition to a complete physical examination and history, X-rays are often taken. X-rays enable the physician to measure joint angles in order to determine the severity of the condition. It also allows the physician to rule out fractures or other pathological processes.
Treatment can be divided into non-surgical (conservative) and surgical treatments.
Surgical Treatment: Surgery is sometimes necessary when the pain from a bunion is extremely severe, or when a bunion has grown past certain limits. The success rate for bunion surgery is very high, especially when measured in terms of performing your ADL’s (activities of daily living) and pain reduction. Complications from surgery include: infections, nerve damage, scar tissue formation, over or under-correction, and blood clots. It is also import to note that the bunion can reoccur if the underlying factors that caused the initial bunion formation are not properly dealt with. The surgery it self may alter the pressure pattern on the bottom of the foot (alignment), causing certain biomechanical imbalances.
Please Note: Something to keep in mind for professional dancers; a bunion surgery will often be the end of that dancer’s career. This is because most dancer cannot return to their pre-operative state.
Conservative Treatment: The objective of conservative treatment is to prevent the progression of the bunion by correcting the biomechanical stress on the foot, realigning the joint as much as possible, and increasing the intrinsic strength of the foot.
Fortunately, in most cases surgery is not necessary, and conservative treatment can be very successful, especially when the following factors are addressed:
· Shoes: Sorry - but those high heels will have to go (except on the rarest of occasion) - especially when the bunion is extremely painful. The best shoes for bunions are flat shoes with a wide toe box. If you wear shoes that rub against your bunion it will only get larger. Some of the best choices are: wide athletic shoes, crocs, and sandals. The only problem with sandals is that you will not be able to wear orthotics within them to correct excessive pronation (if over-pronation is part of the problem). You can also try a shoe stretcher to increase the space in your current shoes.
· Soft Tissue Restrictions: It is essential to remove soft tissue restrictions in order to bring the big toe back into its neutral position. Without addressing these restrictions, the bunion will continue to expand. There are various techniques that can be used to break up these restrictions such as Active Release Techniques, Graston Techniques, Massage Therapy, or various types of fascial manipulation. The exact area of restriction will vary for each individual case. Using a golf ball on the bottom of your foot and performing self-massage can also be of great benefit.
· Foot Stability: Besides the obvious restrictions that may be found in the Adductor Hallucis, we also have to consider the other muscles that are involved in stabilizing the entire foot. Think of your foot the same way you would think of your car. Your car has four tires, each of which must be kept in alignment. If one of your tires is out-of-alignment, it affects the motion of the entire vehicle. The same thing occurs with the muscles of your feet. It only takes a restriction in one muscle to affect the stability of the entire foot
In part three of Bunions – Hallus Abductor Valgus, I will cover the specific anatomy involved in bunion formation, from the perspective of overall foot stability and identify which structures may need to be treated.

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