• Bunion or Hallux Limitus is a term that indicates prominence of bone at the big toe joint. With bunion deformity, the first metatarsal bone has spread upward. The big toe is displaces upward and jams on the first metatarsal head. The entire ray becomes bent and crooked. This displaced joint can become arthritic, stiff and painful.
  • The influence of pathomechanics and foot gear on the deformity was explained. Pronation of the rearfoot during walking causes instability at the base of the first metatarsal allowing it to move up and out of position. The big toe joint then becomes progressively more and more subluxed. Recommend use of sneakers and accommodative footgear including customized innersoles and orthotics. It was explained that orthotics address the biomechanical cause of problem, pronation of the rearfoot. Control of pronation reduces the deforming forces that make bunions worse.
  • Non-surgical treatment for bunions was discussed. Non-surgical remedy includes, padding, accommodative shoe gear, orthotics to control pronation, and padding. These options were offered to the patient. Cutting Edge laser therapy can be applied to the joint to reduce inflammation and pain. It will not remove bone spurs. Steroid injections are sometimes used but have only temporary effect and weaken the joint capsule.
  • It was explained that surgery is always an elective procedure for bunions or hallux limitus.
  • Surgical correction was explained. Under sedation and local anesthesia at the hospital an incision is made on the top of the joint. Excessive bone is removed from the metatarsal head. Depending on the structure sometimes a V shape osteotomy is cut in the neck of the first metatarsal to shorten it and relieve pressure on the joint. Other times a titanium joint replacement implant can be inserted to improve the range of motion and decrease the pain. It was explained that patient is usually permitted to walk using a surgical shoe or cam walker boot and that healing usually takes 2 to 4 months.
  • Potential risks and complications were explained including, infection, thick or ugly scarring, numbness, failure to heal, fixation failure and removal by another operation, over correction of the hallux, abnormal position of the hallux, stiffness of the big toe joint, continued pain in the big toe joint, pain under the second metatarsal and recurrence of deformity.
  • The patient confirmed understanding counsel.

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