A 65-year-old retired secretary presents with a painful bump associated with the medial aspect of the first metatarsophalangeal joint. She reports that the bump has developed over the past ten to 20 years. What is the most likely diagnosis?
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Contributed by Scott Dulebohn, MD
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Hallux valgus, commonly called a bunion, is more common in women than in men. Symptoms include a painless or painful bump, called an exostosis, that forms on the medial aspect of the first metatarsal phalangeal joint. Contributing physical factors include hyperelasticity syndromes, metatarsus varus, a short first metatarsal phalangeal joint, and pes valgus.
Other factors include a family history of bunions and the prolonged use of narrow, high-heeled shoes. Conservative treatment is usually all that is needed and includes wide shoes, the use of bunion pads, ice, rest, and anti-inflammatory agents for acute pain.
Most cases referred for surgery have intermetatarsal angles greater than 10 degrees or fail to improve with conservative measures. Absolute contraindications for surgery include peripheral vascular disease and local tissue infections, whereas relative contraindications include narcissistic personality disorders, painless cosmetic bunions, and age 65 years or older.
A bunionette is a bony prominence on the lateral aspect of the fifth metatarsal head.
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