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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Structures at Risk From an Intermetatarsal Screw for Lapidus Bunionectomy: A Cadaveric Study., So E,Van Dyke B,McGann MR,Brandao R,Larson D,Hyer CF,, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2018 Nov 15 [PubMed PMID: 30448378]
Hallux Valgus Correction With Rotational Scarf Combined With Adductor Hallucis Tendon Transposition., Boychenko AV,Solomin LN,Belokrylova MS,Tyulkin EO,Davidov DV,Krutko DM,, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2018 Nov 15 [PubMed PMID: 30448186]
Hallux Valgus Surgery in the Athlete: Current Evidence., Fournier M,Saxena A,Maffulli N,, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2018 Nov 14 [PubMed PMID: 30448185]
The Use Of Suture Anchors In Akin Osteotomy : A New Surgical Technique., Kilinc CY,Kilinc B,Acar E,Kilinc RM,Aykut S,Oznur A,, Acta orthopaedica Belgica, 2017 Dec [PubMed PMID: 30423669]
[Short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures in treatment of hallux valgus associated with mild to moderate metatarsus adductus]., Qu F,Cai J,Liang X,Lu J,Zeng Q,Ji W,, Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery, 2018 Nov 1 [PubMed PMID: 30417613]