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.

拇趾外翻治療概念

非手術治療方式

暫非手術治療方式主要是舒緩拇趾外翻所引起的痛楚，較實際及有效的方式是穿著較為舒適的鞋子,以較平、寛鬆、柔軟鞋面、鞋底較厚或露趾鞋的鞋子來減輕拇趾外翻的痛楚。消炎止痛藥亦可暫時解除痛楚，而物理治療及其運動可作出某程度上的幫助，但不能矯正外翻的問題。把拇趾拉直的輔助工具或有助於輕微的症狀，但沒有證據證實能幫助外翻的問題。處方鞋墊可用來緩和惡化的情況及處理足繭的問題。

手術治療

一直以來，已發展超過150種不同的拇趾外翻手術方式，全球現今流行的方法亦有10種多種。眾多不同的方式可能是由於直到目前為止，仍未有一種最理想的手術方式被醫生一致公認。

拇趾外翻治療的目標

拇趾外翻的最終目標應該是幫助拇趾恢復正常功能、解除患者痛楚及處理因拇趾外翻而引發的連串問題。






參考資料: http://www.bunioncenter.com/bunion/chi/treatment-concept.html
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。

A pertinent analogy: Leaning Tower of Pisa

Bunion deformity is fundamentally formed by the loosened first metatarsal bone that has lost its ligamentous support and thus tilts abnormally to one side.

This scenario is not unlike the Leaning Tower of Pisa which has also lost its external support of a weak foundation. Both first metatarsal bone and the Tower are basically unchanged and normal in shape by themselves.

To upright the Tower by the "break-n-shift" concept as in traditional bone-breaking bunion (hallux vaglus) surgery would not only induce unnecessary damages to the normal and innocent Tower itself, but also fail to address its underlying issue of a weak foundation.

Similarly, the normal and innocent first metatarsal would also be damaged of its function and not stabilized against future recurrence of tilting.

Reference information: www.bunioncenter.com

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.

拇趾外翻手術的疑問

 

1. 據說拇趾外翻手術康復過程很痛及復原期長，是否屬實？

是！但通常適用於截骨手術。因吳醫生的韌帶聯合術不須截骨，痛楚較輕及較早通常在手術1-2天後便消失，復原過程也較少不便。



2. 可否雙腳一起進行手術？


可以！這亦是大部份雙足患者的普遍選擇。



3. 手術是否需要移植人工物料？


不用，為一外來物料只是一些可溶性的縫線。



4. 有什麼可能的併發症？


可能會出現併發症，但與截骨手術相比，併發症出現機會較低和較輕微。最常見的併發症是於手術附近的拇趾表面的有輕微麻痺，傷口感染、過度矯正、第二及第三蹠骨分離和因患者術後初期過度步行而導致的復發和趾骨勞損等問題，但此類併發症出現的機率約為5%。



5. 醫療保險是否保障拇趾外翻手術？


保險是保障的。因拇趾外翻手術主要是針對治療足部痛楚和功能恢復，外觀亦會跟隨著功能性手術而得以改善。但仍建議先與保險公司查詢為準。



6. 如有需要，手術可否重複再做？


有別於一般截骨手術，韌帶聯合術不會破壞足部正常結構，如有需要，可以再次施行韌帶聯合術，患者亦不會有嚴重的影響。



7. 手術過程需時多久？


約1小時。



8. 手術可否局部麻醉下進行？


可以！






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。

Many people talk about bunion surgery being painful and a long recovery, is this true?

1. Many people talk about bunion surgery being painful and a long recovery, is this true?

Yes, it is the case after certain types of bone-breaking surgery. Since Dr. Wu's syndesmosis procedure does not need to break any bones, its pain is usually much less and for 1-2 days only. Its recovery period is much less incapacitating.


2. Can both feet be corrected at same time?

Yes, this is usually the preference by patients with bilateral bunion condition.


3. Are there any artificial implant such as screws and pins used?

No, the only foreign material used is the ordinary surgical sutures and they are dissolvable.


4. What are the possible complications?

Complications are possible but a lot fewer and milder in comparison to the "break-n-shift" surgeries. The possible complications are numbness around the wound (on top of great toe), wound infection, over-correction, early partial recurrence and stress fracture due to excessive walking and separation between second and third metatarsals. There has been no known late recurrence or transfer metatarsalgia.


5. Do medical insurances cover bunion surgeries?

Yes, they do because bunion surgery is considered necessary for pain relief and function improvement of the foot. But it is always advisable to get written approval from your insurance company ahead of surgery.

Reference information: www.bunioncenter.com

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.

拇趾外翻可藉韌帶聯合術痊癒

不少女性患有拇趾外翻毛病，藝人鄧麗欣亦曾經是患者。她表示，10多歲時已患有腳趾外翻，入行後更經常穿高跟鞋，劇痛難耐，直至五年前接受了非截骨拇趾外翻手術，至今並無翻發。


藝人鄧麗欣表示，她曾受拇趾外翻困擾，在接受非截骨韌帶聯合術後，至今無復發，可如常投入幕前工作。


不需要截骨 可預防復發

骨科醫生吳彥為鄧麗欣操刀，他表示，拇趾外翻術後復發是其中一個比較普遍的問題，傳統上，大多數醫生都會採用多種不同的方式先將第一蹠骨截斷，然後再將它的前段移位，從而改直。不過他說，已有55年歷史的韌帶聯合術，可以利用一般的手術逢線將偏移的第一蹠骨與旁邊堅固的第二蹠骨綁在一起，這便可將第一蹠骨拉直，並非一定需要截斷任何骨頭。
他稱，將第一蹠骨拉直後，韌帶聯合術也會引發兩條蹠骨之間自然生長些韌帶纎維之類的軟組織將它們聯合在一起，從而穩定第一蹠骨，亦可預防術後復發。






 




參考資料:成報
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。