Bunions / arthritis
A bunion is a deformity of the great toe joint where the 1st toe drifts towards the lesser toes. Usually, a prominent "bump" forms on the inside of the foot as a consequence of the joint becoming more prominent. Often, the smaller neighbouring toes drift out of position and this is one indication for surgery so as to to avoid the development of a more extensive forefoot deformity.
When the bunion presses on shoes, then the only solution is wider shoes or surgical correction. When pain arises within the great toe joint, then specialised insoles, various types of injection and shoe modification can be undertaken.
There over a 100 different types of bunion operation although a handful of operations are mainly used within the UK. At our Centre minimally invasive surgery is sometimes undertaken but only if the bunion is suitable as large bunions requiring a layered more complex correction that can best undertaken by means of an open approach, so that the surgery can correct all aspects of the deformity. Operations at our Centre are performed under local anaesthetic on a day care basis and patients usually go home within a few hours. No cast is generally required and post operative pain is well controlled thanks to the use of long acting anaesthetics.
HALLUX RIGIDUS / GREAT TOE ARTHRITIS
Sometimes the great toe joint becomes arthritic and stiff without significant deviation. This condition is often referred to as hallux rigidus. When the toe is limited in movement (but not completely stiff) is sometimes referred to as hallux limitus.
There are a number of Conservative techniques to treat the condition and certain types of footwear and specialist orthotic can be helpful. Injections also play a role including the use of hyaluronic acid.
When conservative care fails then surgery will depend on the amount of damage to the joint. In mild to moderate cases the arthritic bone can simply be cut and shaved away leaving the majority of the joint intact. This procedure is often referred to as a cheilectomy. When possible, this is the preferred approach. However in some cases the arthritis is to extensive and in such circumstances three main surgical options exist. These consist of a joint fusion, the use of artificial joint or an interposition of arthroplasty.
Fusions should be avoided if possible (although sometimes there are no other reasonable options) because of their adverse biomechanical effect on walking. Patients with fused joints are, in the Centres experience more likely to experience knee pain and other symptoms because of an alteration in gait. Artificial joints can be successful, but some patients develop resistance, whilst in others the joints fail and the toe remains very stiff. At the London podiatry Centre, when possible we prefer to use a modified into positional arthroplasty technique. This has been developed and pioneered within the centre to include a number of refined additional steps. The operation results in the patient’s own tissue being used to create a spacer after the removal of some bone from the great toe joint. Recovery is fairly rapid and the procedure is generally undertaken under local anaesthetic. Most patients can return to work within 2 to 3 weeks and the toe remains mobile so facilitating a more normal gait.
CASE STUDY
This patient had identical toe deformities on each foot and opted to have the left, more painful foot operated on first. The left foot has been surgically corrected at the Centre.
The patient was able to walk immediately after her operation and no cast was required.
