Bone Health

Core Curriculum
Objectives
1. Define adolescent bunion and describe the pathologic anatomy
2. Describe the clinical and radiographic features of adolescent bunion
3. Discuss conservative management of adolescent bunion
4. Discuss structural components of a successful surgical correction
5. Describe several procedures used for treatment of adolescent bunions and the quality of the results reported for these procedures

Hallux Valgus is a condition which affects the joint at the base of the big toe. The condition is commonly called a bunion. The bunion actually refers to the bump that grows on the side of the first metatarsophalangeal(MTP) joint. In reality, the condition is much more complex than a simple bump on the side of the toe.

One of the more common conditions treated by podiatric surgeons is the painful bunion. Patients with this condition will usually complain of pain when wearing certain shoes, especially snug fitting dress shoes, or with physical activity, such as walking or running.

Authors: Richard T Laughlin, MD, & Emmanuel K. Konstantakos, MD
Hallux valgus (HV), with its accompanying bunion, is a common deformity of the forefoot. Understanding and characterizing each component of the deformity is the key to treating it successfully. Many treatments have been proposed; the best choices are those that directly address the location of the deformity. In order for the most effective surgical procedure to be chosen, the deformity must be carefully characterized
Synonyms and related keywords: hallux valgus deformity, HV deformity, metatarsus primus varus, foot deformity

AAOS: Your Orthopaedic Connection Patient Education Booklets

Definition A bunionectomy is a surgical procedure to excise, or remove, a bunion. A bunion is an enlargement of the joint at the base of the big toe and is comprised of bone and soft tissue. It is usually a result of inflammation and irritation from poorly fitting (narrow and tight) shoes in conjunction with an overly mobile first metatarsal joint and over-pronation of the foot. Over time, a painful lump appears at the side of the joint, while the big toe appears to buckle and move sideway towards the second toe. New bone growth can occur in response to the inflammatory process, and a bone spur may develop. Therefore, the development of a bunion may involve soft tissue as well as a hard bone spur. The intense pain makes walking and other activities extremely difficult. Since the involved joint is a significant structure in providing weight-bearing stability, walking on the foot while trying to avoid putting pressure on the painful area can create an unstable gait. Encyclopedia of Surgery: A Guide for Patients and Caregivers

Hallux valgus is a condition in which the big toe migrates laterally toward the second toe. This results in a bump on the inner side of the foot, know as a bunion. It is related to a combination of genetic factors, activities, and inheritance. Some patients who have this condition do not have symptoms. Sometimes symptoms can be relieved just by modifying the shoe to have enough room in the forefoot to accommodate the changed shape. (Further pages)

Bunions: Rothman Institute

Etiology: intrinsic and extrinsic factors Vascular and neurologic review Indications and contraindications Radiographic and clinical evaluation Technique of regional ankle block Indications, disadvantages of tourniquet Surgical technique with soft tissue release Postoperative management Potential complications

Sports Medicine: Conservative approach benefits athletes with hallux valgus
Success should be gauged by the ability to resolve the athlete’s complaint of pain and loss of function in a timely fashion.
By Joseph P. Laluya, DO, Terry Nicola, MD, and Sarah McDade, MD
As more people participate in sports and extend this interest into the later decades of life, we are seeing an increasing number of hallux-valgus-related injuries. Historically, hallux valgus has been treated with surgical intervention. However, as our experience with and knowledge about the condition increases, a noninvasive therapeutic approach warrants consideration.
Hallux valgus presents as lateral deviation of the great toe and medial deviation of the first metatarsal bone. Commonly, the deformity is characterized by progressive subluxation of the metatarsophalangeal joint.

It is the intention of this report to provide a brief overview of destructive surgery of the first metatarsophalangeal joint, emphasizing current indications, surgical procedures and potential complications which may arise.
A historical perspective of destructive joint surgery
Indications for destructive surgery of the first metatarsophalangeal joint
The Mayo Procedure
The Keller Procedure
Implant arthroplasty of the first metatarsophalangeal joint
Arthrodesis of the first metatarsophalangeal joint

Wheeless' Textbook of Orthopaedics
Overview of options for the investigation and management of hallus valgus

Presentation on the subject by East Lancashire Foot and Ankle Hyperbook. Contents - Introduction & anatomy, epidemiology, first ray instability, aetiology and pathogenesis, history, examination, investigation, non-surgical management, introduction to surgery, specific operations, choosing a procedure, complications

Authors Crista J Frank, DPM, Dan E Robinson, DPM & Dale D Dalenberg, MD
Hallux valgus is considered to be a medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux with or without medial soft tissue enlargement of the first metatarsal head. This condition can lead to painful motion of the joint or difficulty with footwear.
Synonyms and related keywords: hallux abductovalgus, HVA, bunion deformity, metatarsus primus varus, metatarsus primus adductus, foot deformity, Reverdin procedure, Reverdin's procedure, hallux rigidus

Powerpoint Presentation on the anatomy and management of Hallux Abducto Valgus and Hallux Varus. C.S.Helu DPM Podiatry Resident NYCH