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A podiatrist discusses what a bunion is , how it occurs, and various treatment options available
@marcbarry1000
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0:00
what is a bunion otherwise known as Halu
0:03
valgus a bunion is a deformity of the
0:05
big toe joint this type of pathology is
0:09
usually manifested as a bump on the
0:11
inside of the foot just behind the big
0:13
toe the bump can be very small or
0:16
reasonably large the size of which is
0:18
not necessarily proportional to the
0:20
amount of pain one can
0:22
experience along with this bony bump
0:24
there can be an Associated btis which is
0:27
a cushion that the body originally
0:28
creates to protect an area from pressure
0:30
or friction but after a while this
0:32
cushion can also become inflamed and
0:35
painful the last component of this
0:37
deformity is the deviation of the big
0:39
toe as it moves toward the second toe
0:42
sometimes even underlapping or
0:43
overlapping the second toe what causes
0:47
bunions poor fitting and high style
0:50
shoes are usually blamed as the culprit
0:52
for the formation of this deformity that
0:54
is why they are more prevalent in women
0:57
but is that really what causes bunions
1:00
the truth is most of these deformities
1:02
are based on a particular foot structure
1:04
and the way a person walks these are
1:07
inherited
1:08
traits this is one of the reasons you
1:10
can see this development in children who
1:13
typically wear very conservative
1:15
shoes the biomechanics behind hu valgus
1:19
formation the short story is feet that
1:21
have a tendency to excessively pronate
1:23
caus an over flattening of the foot this
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excessive flattening causes excessive
1:28
tension on the extensor hallucis long
1:30
this tendon the tendon on the top of the
1:32
foot that enables you to bend your big
1:34
toe
1:35
upwards this causes the tendon to
1:38
boering in doing so this forces the big
1:41
toe to be pulled laterally toward the
1:43
second toe this is what causes the
1:45
initial
1:47
deviation over time there is a
1:49
retrograde or backward Force placed on
1:51
the first metatarsal bone by the big toe
1:55
the first metatarsal bone begins to move
1:57
medially or away from the second
1:59
metatarsal bone due to these changes
2:02
there is now more pressure on the side
2:04
of first metatarsal bone from shoe
2:06
pressure and this causes a hyperostosis
2:08
or thickening of bone and this results
2:10
in the bump that you see and feel on the
2:12
inside of the foot this deformity also
2:15
creates an unequal alignment of the
2:17
joint itself and causes the joint to
2:19
wear out over time once the joint is
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worn down sufficiently pain ensues when
2:25
you try to bend the toe while walking so
2:28
the biomechanics of the foot is really
2:30
what causes
2:31
bunions in theory if you lived on a
2:34
tropical island and never wore shoes
2:36
your whole life you could still develop
2:38
Halu
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valgus generally speaking Halu valgus is
2:42
a progressive deformity and in most
2:44
people will worsen over time if
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appropriate measures are not taken to
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remove the underlying cause bunan
2:52
symptoms the most common pain associated
2:54
with Halu valgus is the pain that occurs
2:57
from the inflamed Buel Sac also known as
2:59
a
3:00
itis typically there will be a burning
3:03
sensation in that area of the foot
3:06
inspection will reveal swelling in
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redness this can occur even with very
3:10
small bumps on the side of the foot
3:13
shoes particularly women's dress shoes
3:16
create a lot of pressure against the
3:17
bone and the body's reaction to that is
3:19
to form a busel sack which initially is
3:22
designed to protect the area but
3:24
invariably will become inflamed and
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begin to hurt whenever I do bunions
3:29
surgery I always look for and have
3:32
removed inflamed busel sacks even
3:35
without a btis the Bony bump can become
3:37
painful again usually aggravated by
3:39
dress shoes but in many individuals even
3:42
conservative shoes like sneakers will
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cause pain the size of the bump and the
3:47
activity level of the patient are two
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factors that will lead to bump pain in
3:52
this instance there does not necessarily
3:54
have to be swelling in
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redness this pain is usually only
3:58
evident when wearing shoes and will vary
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with the type of shoe being worn the
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other type of pain in this condition is
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what is known as joint pain as the big
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toe starts to move closer to the second
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toe it creates an abnormal alignment in
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the big toe joint this causes a
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premature erosion of cartilage and over
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time the joint will no longer move
4:20
smoothly and the patient will start to
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experience pain and limitation of motion
4:24
of the big toe this type of pain can be
4:27
experienced both in and out of shoes
4:30
treatment and
4:32
prevention just because you have this
4:34
deformity does not necessarily mean you
4:36
have to have treatment in the
4:38
asymptomatic or non-painful deformity it
4:41
is more prudent to find the underlying
4:43
cause of the deformity and make changes
4:45
accordingly having said that I can tell
4:48
you that over the years I have had
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patients come to me with what appears
4:52
like a golf ball growing on the inside
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of their foot and they swear to me that
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it does not hurt non-surgical bunion
4:59
treatment
5:00
the use of
5:01
orthotics so what an orthotic does in
5:04
these cases is to reduce the over
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flattening of the foot which then
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results in an improved alignment of the
5:09
joint and reduction of pain in the joint
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itself the degree of relief is probably
5:14
inversely proportional to the degree of
5:16
damage that is already done this means
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Orthotics generally will work on mild to
5:22
moderate bunion pain but not severe pain
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keep in mind that Orthotics especially
5:27
in women will require a wider if not
5:29
slightly longer shoe so if a shoe that
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is tight and irritating a bunion to
5:34
begin with has an orthotic added to it
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the shoe becomes even Tighter and more
5:39
painful this therapy will not make the
5:42
existing deformity disappear but it
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should slow down or eliminate further
5:46
worsening of the condition sensible
5:48
shoes elimination of shoes that are
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either too narrow to flimsy in support
5:53
or too high in the heel trying to wear a
5:56
narrow High style shoe with a large
5:58
great toe deformity is like trying to
6:00
put a square peg into a round hole it
6:02
just does not fit this kind of mentality
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will eventually lead to a worsening of
6:07
the condition do bunion splints and
6:10
cushions work cushions braces and
6:13
splints that are sold for this condition
6:15
are not my first choice because in most
6:17
cases they just take up more space in
6:19
the shoe and put more pressure on the
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bump my only exception to this is in
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people who are experiencing joint pain
6:27
the best bunion splint therefore is one
6:29
worn at night that will keep the toe
6:31
straight but not create excessive
6:33
pressure within the shoe I have also
6:35
been known to use these splints after
6:37
surgery for a short time in an effort to
6:40
keep the joint properly aligned during
6:42
the healing process more aggressive
6:45
treatments for bunions include
6:47
anti-inflammatory medication which is
6:49
fine for short-term use but should never
6:52
be considered as a solution in that over
6:54
the Long Haul the medication will lead
6:56
to systemic problems in most
6:58
individuals cortisone injections can be
7:01
very helpful in those have btis pain and
7:03
to a lesser extent for those suffering
7:05
from joint pain Physical Therapy can be
7:08
helpful in relieving flare ups for those
7:11
where conservative care does has not
7:13
worked surgery is the next
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consideration the question frequently
7:18
Asked of me is when to have surgery to
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correct this
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deformity it is estimated that over
7:24
200,000 people per year have Halu valgus
7:27
surgery in the United States my criter
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Bia is simple when the pain of the
7:32
deformity starts to affect your everyday
7:34
life on a regular basis for example you
7:37
no longer golf or go for daily walks or
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go shopping with your friends out of
7:42
fear that your foot will start hurting
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having said that keep in mind that Halu
7:47
valgus surgery is not without risks as
7:50
is any kind of surgery and that the type
7:52
of surgery your friend may have had may
7:54
not be the type you will require the
7:57
well-trained podiatrist probably has at
7:59
least a half dozen different types of
8:01
procedures based primarily on the size
8:03
of
8:04
deformity the type of procedure will
8:06
usually determine the length of
8:09
recuperation the risks of Halu valgus
8:11
surgery include the following a chance
8:14
of infection which is true in all
8:16
surgery loss of motion or joint
8:19
stiffness where the big toe does not
8:22
Bend although in some procedures this is
8:24
expected and the end result is the joint
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no longer hurts another potential
8:29
complication is delayed healing because
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of the dependent nature of the foot
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there is usually more swelling than in
8:36
other parts of the body so healing may
8:38
take longer additionally is the risk of
8:41
surgical failure whereby you are no
8:43
better off after surgery than you were
8:45
before the
8:46
procedure next is the possibility of
8:49
non-un in procedures where the
8:51
metatarsal bone has to be broken and
8:53
reset in an effort to reang late the
8:56
bone there is always the possibility
8:58
that the broken bone will not not heal
9:00
there is also the risk of implant
9:03
failure in the case of a joint implant
9:05
there is always the possibility it may
9:07
have to be removed due to infection or
9:09
reaction to the materials of the
9:12
implant lastly you should be aware of a
9:14
recurrence of the deformity over a
9:16
period of years the type of anesthesia
9:19
used in this type of surgery ranges
9:21
anywhere from local anesthesia where
9:23
just the foot is put to sleep to
9:25
intervenous sedation Twilight sedation
9:28
with local anes athesia to general
9:31
anesthesia the vast majority of my
9:33
patients are done under local anesthesia
9:35
with intervenous sedation on an
9:37
outpatient
9:38
basis I prefer this type of anesthesia
9:41
because the patient feels no pain is not
9:44
having general anesthesia and all the
9:46
potential risks associated with general
9:48
anesthesia and tends to be awake shortly
9:50
after surgery with less chance of being
9:52
sick from the anesthesia during the
9:54
following 24 hours
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