24- Bunions

Question 1

def of bunions

Answer 1

greater than 15 degrees of angulation of great toe towards others

Question 2

steps of bunion formation

Answer 2

1. medial sesmoid + medial collateral ligs fail
2. metatarsal head slips off sesamoid tracks
3. prox phalanx moves valgus
4. metatarsal head sits on medial sesamoid wearing out crest
5. bursa thickens laterally
6. EHL bowstrings and pulls phalanx more valgus
7. metatarsal head pronates
8. adductor hallicus dominates

Question 3

risk factors/age of bunions

Answer 3

F

footwear, genetics, overpronation

Question 4

Main risk factors of bunions (met length, footwear, overpronation) coorelation

Answer 4

• Halux valgus associated w increase 1st met length, round metatarsal head and lat seasmoid displacement
• Footwear/overpronation were less conclusive

Question 5

QOL and untreated hallux valgus

Answer 5

lower than gen pop

Question 6

in W hallux valgus is associated w

Answer 6

Lower BMI

use of high heeled shoes as their usual shoes during ages of 20-64

Question 7

In M hallux valgus is associated w what

Answer 7

higher BMI

pes planus

Question 8

Overall conservative tx of bunions

Answer 8

Best handled by footwear (wide toe box( and activaty mod

-cannot reverse deformity, however can help symptomatically

Question 9

Orthotics and progression of hallux valgus

Answer 9

no effect

Question 10

what orthosis would u use if you had to in bunions

Answer 10

(a foot orthosis w medial arch support could reduce pressure beneath the hallux and 1st metatarsal by transferring load to other regions)

-3/4 length orthosis might be a better choice than a sulcus or full length orthosis

Question 11

custom orthosis and bunion

Answer 11

limited evidence on which to base clinical decisions regarding the prescription of custom made foot orthosis for tx

Question 12

rocker shoes/ inserts with toe cut out effects

Answer 12

both increased peak pressure under the midfoot and lesser toes (both reduced pressure under first MTP jt)

-may work by redistributing load away from the 1st MTP jt, possibly shifting it toward the medial longitudinal arch during mid stance and toward lesser toes during propulsion

Question 13

custom made orthosses and evolution of hallux valgus in one year

Answer 13

no sig difference (between or at follow up)

Question 14

what are the 3 types of seasomoids

Answer 14

1. hallucal sesamoids (1st metatarsal head)
2. interphalangeal jt seasimoids
3. Lesser metatarsal sesamoids

Question 15

2 functions of hallucal seasmoid

Answer 15

1. to act as anatomic bully for flexor hallucis brevis

2. To act as tunnel to protect flexor hallucis longus tendon

Question 16

what is the jt rxn force going through the MTP jt during toe off

Answer 16

80% of bodyweight

can increase up to 800% when jumping

Question 17

trauma of sesamoid causes + mc one

Answer 17

• medial hallucal fx more frequent
• decleration injuries such as falling from a height common
• reppetative dorsiflex

Question 18

seasamoiditis and what is risk w them

Answer 18

chronic pain can be caused by this

-can lead to stress fx, osteoarthritis and osteonecrosis

Question 19

what is the orthotic solution for sesamoiditis

Answer 19

reverse mortons extension

Question 20

what is turf toe and causes

Answer 20

hyperdorsiflexion injury originally caused by artificial turf, not allowing the foot to skid across ground

-could happen when players foot gets stuck to ground and causes the player to fall (back /forward)

Question 21

orthotic solution for turf toes

Answer 21

ridged mortons extension