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bunion - Coggle Diagram
bunion
Assessment
if a person has a bunion based on the initial clinical features presence and duration of symptoms such as forefoot and or first MTP
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observe the persons gait and lower leg alignment, examine the persons foot/feet in a standing and seating position
assess the degree of hallux deformity and presence of pes planus while standing, assess skin quality and examine for associated complications such as calluses, corns, bursitis, skin breakdown and lesser toe deformities
palpate the first MTP joint, lesser toes and forefoot for areas of the pain and tenderness
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assess the ROM of the first MTP joint, other foot joints and ankle, stiffness and rigidity of the first MTP joint may indicate associated osteoarthritis
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examine the type and wear patterns of footwear and assess shoe fit, do not routinely arrange foot xray in primary care
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Diagnosis
suspect a bunion deformity if a person presents with progressive pain at the medial aspect of the first MTP joint and or medial aspect of the forefoot.
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Definition
a bunion described a toe deformity when the great toe laterally deviates away from the midline towards the lesser toe. This causes medial prominence of the first metatarsal head and overlying bursa and soft tissue may also become inflamed.
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lateral deviation of the proximal phalanx from the first metatarsal greater than 15 degrees and an intermetatarsal angle greater than 9 degrees on weight bearing x-rays are considered abdominal
Complications
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skin breakdown and foot ulceration and risk of osteomyelitis, particularly in people with diabetes and associated peripheral topics
management
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give advice on self care measures for symptoms relief, advise and proper shoe fitting
consider to use insoles, toe spacers and bunion pads
consider inflammation relief, advise on analgesia
offer referal to podiatry for footwear assessment, or consider referral to the local musculoskeletal service
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arrange urgent referral to an appropriate specialist if there is non healing foot ulcer or suspected limb ischemia
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