足部 - 大自然奇妙的創造

我們每天都對自己的足部施加比身體其他部位更多的壓力，由每天步行或一般至劇烈運動，我們的雙腳均扮演著一個可以承受各式各樣力量衝擊的角色，正因如此，足部是我們身體最奇妙和複雜的結構之一。


對比只有四條骨骼的腿部，正常足部是由26片特殊形狀和比例的骨骼並以超過100條韌帶、肌肉和筋等組成，在這精密的結構中有任何異常的情況；都會阻礙患者發揮正常的功能，也難以應付日常生活所帶來的壓力。


所以每一個手術，如若對足部結構作出非必要的改動時，都難免會影響足部功能，此理念在治療拇趾外翻問題尤其重要。

參考資料: www.bunioncenter.com/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

Bunionette and Bunion Deformity

Background:

It may be wrong but easy to blame the obvious. Bunionette is a perfect case in point. Most bunionettes are not at fault for its own pain but the bunion.



What is the bunionette (baby/tailor’s bunion)?

Bunionette is the bony prominence at the base of small toe from the opposite side of the bunion of big toe. The prominence is actually part of the normal anatomy of 5th metatarsal head. While bunion deformity is almost always abnormal, bunionette is mostly normal to the contrary of popular belief.



How would bunion contribute to bunionette pain?

Firstly, bunionette can only be painful in close-toe shoes that are either too narrow for a normal width forefoot or when the forefoot is too wide for regular shoes. Bunion increases the width of forefoot and thus tightness of regular shoes. Thus both bunion and bunionette would rub more against their side of close-toe shoes fighting for room. Therefore, bunionette is another victim of the bunion condition.

Another reason is the outer-side of a bunion foot has to bear abnormally more weight in walking due to function loss on the big toe side of a bunion foot.



Why would poor big toe function contribute to bunionette pain?

The big toe side of foot normally provides most (up to 80%) power for all foot activities. Bunion deformity impairs its function and inadvertently depends more on outer side of foot for walking. This would thus increase the pressure on bunionette against shoes and thus pain.



Should then bunion surgery also resolve bunionette pain?

Yes, an effective bunion surgery will not only narrow the forefoot significantly but also restore function of the big toe side of foot and thus spare bunionette of abnormal crowding and pressure and thus pain



Why do some bunionette pain persist after bunion surgery?

Some bunion surgeries may be able to straighten out the big toe to look better but not really narrow the forefoot to solve the crowding problem in regular shoes.

Even if a bunion surgery can narrow the forefoot but fails to restore big toe function may not help relieve pressure on the bunionette enough in walking for complete pain relieving.



Has syndesmosis procedure been able to help resolve bunionette pain and why?

The non-bone-breaking bunion surgery by syndesmosis procedure has been demonstrated by the Biomedical Engineering Department of Hong Kong Polytechnic University to be able to not only narrow the forefoot effectively but also restore the big toe function. After more than 1,600 syndesmosis procedures there has not been any need for surgery to relief bunionette pain yet in our experience.










Reference information: http://www.bunioncenter.com/bunion/bunionette.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.

Body Balance and Bunion Deformity

Background:

During walking body needs to balance itself from one foot during its stance phase to the other foot alternately. The ability to balance properly on one foot relies much on the normal function of big toe.


Why is big toe important for balance?

Big toe is not only the biggest but also more importantly strongest of all toes. We rely on our toes to lean forward and push against the ground for walking and prevent us from falling. Big toe may contribute up to 80% of all power required to do so. If big toe side of foot is weak due to the bunion condition, it may not be strong and reacting quick enough to prevent occasional sudden imbalance and fall. We need healthy big toes to maintain body balance especially for walking fast, on uneven ground and down the stairs or slopes.


How does bunion compromise body balance?

Bunion deformity destructs the power and stability of big toe. Thus bunion sufferers will find walking gradually becomes more difficult and tiring besides pain. Balance during the stance phase of walking will thus become poor and unsteady as bunion deformity worsens. Unexpected sudden falls can become a problem.


How do sufferers compensate for their compromised big toe function and ability to balance?

They will develop gradually more for a compensatory gait by shifting the body center of gravity backwards, away from the unreliable big toe, and walk slower. This altered gait is inefficient and tiring.


Can bunion surgery improve balance?

Absolutely, bunion surgery should be able to improve balance by restoring stability and function of big toes. The improved balance can especially be appreciated by young patients practicing yoga and also reduced falling tendency among elderlies. Syndesmosis procedure can improve balance because its ability to restore proper function of the big toe.







Reference information: http://www.bunioncenter.com/bunion/impaired-balance.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.

Metatarsalgia and Bunion Deformity

Background:

Bunion deformity can give rise to not only disabling bunion pain but also elsewhere in the foot, leg and even low back. It is therefore important to understand how and why they can be affected by the bunion problem or more accurately the impaired foot function in order to find a proper solution for them.



What is metatarsalgia?

Metatarsalgia is the pain under mid-metatarsal region of the forefoot just behind the second and third toe joints. It feels like walking on a pebble in the shoes. It is usually associated with thickening calluses in the same area.



Why is there callus and pain under the mid-metatarsal heads area of bunion feet?

The reason is twofold. Firstly and structurally, transverse metatarsal arch of the forefoot collapses due to destabilization/hypermobility of first metatarsal bone of bunion feet and thus increased contact pressure of the mid-metatarsal heads of a flat/collapsed metatarsal arch against the ground in walking. The other reason is the abnormal lateral shift of pressure/force to the mid metatarsal region for walking after gradual loss of the critical big toe function.



Can the non-bone-breaking syndesmosis procedure resolve the metatarsalgia problem for a bunion foot and why?

Syndesmosis procedure has been proven capable of re-aligning and re-stabilizing the first metatarsal consistently to restore the transverse metatarsal arch and also function of the great toe to spare mid metatarsal heads from undue pressure/force in walking.



Are there any clinical evidence that the pressure and force is reduced under the mid metatarsal heads after syndesmosis procedure?

Yes, firstly, any preoperative metatarsalgia has been consistently diminished or disappeared after syndesmosis procedure. secondly, metatarsal calluses have also markedly reduced or disappeared. Thirdly, no additional surgery such as Weil osteotomy (break-n-shift of the 2nd and 3rd metatarsals has been needed. Fourthly, plantar pressure study by F-Scan® has also demonstrated significant and consistent migration of forefoot metatarsal pressure in walking from the painful mid-metatarsal region of bunion feet to under the first metatarsal head where it should normally be.








Reference information:  http://www.bunioncenter.com/bunion/metatarsalgia.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.

Low Back Pain and Bunion Deformity

Background:

Low back pain is common in human due to our unique upright posture that exerts more strain and stress in the low back area. As low back spine degenerates with time it will become more sensitive and vulnerable. As bunion feet do not actually damage low back but can irritate it by their compensatory gait.



How can one’s low back pain be connected to bunion foot?

Bunion feet with loss of their all-important great toe function have to compensate by walking more on the outer side of feet. This altered weight-bearing technique would result in a subtle waddling gait from outer side of one foot to the outer side of the other instead of the big toe side of feet which is closer to body’s midline. This swaying of body from side to side can strain the low back and cause pain if walk for long.



How do I know if my low back pain is possibly related to my bunion feet?

Low back pain is a very common condition and more likely caused by aging than bunion feet. A simple way to probably differentiate the two is that bunion related low back pain is usually precipitated by prolonged walking instead of prolonged sitting for the degenerative type of low back pain.



Can bunion surgery alleviate my low back pain?

It is very likely that if any bunion surgery can effectively restore great toe function will also be able to improve the gait and thus reduce irritation and pain in the low back from walking.










Reference information: http://www.bunioncenter.com/bunion/low-back-pain-bunion.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.

Leg and Knee Pain

Background:

Without any underlying problems, leg muscles and joints can become painful due simply to overuse/strain at any time and age.



Can leg and knee pain be caused by bunion deformity?

Yes, the altered gait adopted by more severe bunion sufferers from losing their big toe function is less efficient and thus over-working leg muscles causing muscle or joint pain.

Bunion deformity can precipitate and also accentuate any pre-existing flat foot and pronation conditions, which in turn can produce valgus thrust and strain of the knee joint and muscles.



How would I know if bunion surgery may help my leg and knee pain or not?

It will depend on the chosen surgery, whether it can re-stabilize first metatarsal and restore big toe function or not.









Reference information: http://www.bunioncenter.com/bunion/leg-knee-pain.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.

Clawed toes and Bunion Deformity

Background:

Clawing deformity can happen usually to the second and third toes of a bunion foot. They can be painful due to rubbing against the top of shoes. Their base (metatarsophalangeal ) joints may also dislocate causing joint pain and metatarsalgia.



What are clawed toes?

As the name suggests that the mid joint of a toe is buckled upwards like a claw in shape. They can become severe and precipitate dislocation of the toe eventually if the bunion problem is not resolved and big toe function is not restored.



Why may the clawing deformity be developed in bunion feet?

Clawing deformity happens due to over-working of the lesser toes when big toe gradually loses its function by the bunion condition and they are also further aggravated by collapsing of the transverse metatarsal arch of bunion feet.



How can clawed toes of bunion feet be corrected?

Since they are caused by poor great toe function and collapsed metatarsal/transverse arch, any bunion surgery that can properly restore function of the great toe and the metatarsal arch will then remove the deforming forces on clawed toes to allow them to return to their normal status in most cases without additional surgery (Fig. 1 & 2).



What is the effect of Dr. Wu’s syndesmosis bunion surgery on clawed toes?

If its clawing deformity is not rigid, then the clawed toe can usually be straightened out on its own without additional surgery after syndesmosis procedure to restore big toe function and transverse metatarsal arch. But if clawing and dislocation have been for a long time and might have become rigid then additional surgery may still be necessary.

Reference information:  http://www.bunioncenter.com/bunion/clawed-toes-bunion-deformity.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.

Flat foot and Bunion Deformity

Background:

Foot is made up of 26 uniquely shaped bones that are held together by >100 ligaments and tendons to maintain two (medial longitudinal and transverse metatarsal) reversed suspension-bridge-like springy arches to absorb the tremendous shocks in performing the demanding daily and sports activities. If certain ligaments and tendons are incompetent for whatever reason, then the affected part of foot can collapse and cause function-related problem of foot, such as for flat-foot and bunion conditions.


Flat foot (pronation):

This is probably the most well-known and commonly seen condition of foot caused by incompetent ligaments and tendons that are no longer able to hold up bones to maintain the arch on the inner side of the foot.


Bunion (Hallux valgus) deformity:

This is another well-known foot condition caused by incompetent ligaments. Bunion is formed by the destabilized and displaced first metatarsal bone. Losing its ligament support first metatarsal can be displaced sideway by the stress of weight-bearing activities to form the bunion deformity.


Flat foot and Bunion deformities:

First metatarsal bone forms the distal segment of inner/medial arch of the foot. When it loses its ligament support, it gives way not only in sideway to form bunion deformity but also in upward direction to allows the medial longitudinal arch to collapse and precipitate/accentuate the flat foot condition.


Syndesmosis procedure and flat foot:

Syndesmosis procedure can restore to some extend and particularly stabilize the, static and dynamic, longitudinal and transverse arches of foot by being able to re-align and truly re-stabilize particularly the main culprit, destabilized and displaced first metatarsal bone. Syndesmosis procedure restores the arches statically by restoring the plantar-ward orientation of first metatarsal through the metatarsocuneiform joint configuration when its metatarsus primus varus deformity can be corrected in its entirety without osteotomies. These arches can also be further accentuated dynamically by restoring the windlass mechanism of first ray. These improved arches can be statically assessed by x-ray and photo images (Fig. 1a,b) and also dynamically by plantar pressure scanning of the foot in walking (Fig. 2a,b). Clinically, patients would feel the medial arch and inner side of foot much firmer and stronger for standing and walking. Objectively, the transverse arch is restored by evidence of disappearance or much reduction of preoperative metatarsal calluses.


Osteotomy procedures and flat foot:

While syndesmosis procedure has been shown capable of re-stabilizing first metatarsal to reduce flatness of the medial arch of foot, statically through the metatarsocuneiform joint and also dynamically through the restored windlass effect in walking. However, bone-breaking bunion surgeries would decouple this natural anatomical relationship and surgeons have to instead manipulate the disconnected distal bone fragment to rebuild the arch in a rather tricky if not almost impossible way. Should break-n-shift of the normal first metatarsal bone fail to heal in its pre-calculated position then neither medial and transverse arches nor foot function can be restored, and even postoperative transfer metatarsalgia complication may

Reference information: http://www.bunioncenter.com/bunion/flat-foot.html
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your Orthopedist for diagnosis and treatment.