Bunions are considered a disease of the modern age. Dr. Zelimir Jovanovic, specialist in orthopedics with traumatology, a consultant at the Atlas General Hospital, talks about the bunions issue.
Deformities that orthopedists most often encounter
Dr. Zelimir Jovanovic: ” The foot has a complex structure. Twenty-six bones, over thirty joints and a hundred ligaments. Deformity can occur on any of these segments or parts of the foot. Deformities that we most often encounter are flat feet, bunions, deformities of the toes, as well as some deformities that occur in certain conditions that have nothing to do with the feet in systemic diseases. For example, diabetes and a neuropathic foot. ”
Dr. Zelimir Jovanovic: ” There are studies that show that foot deformities are on the rise. About 23-25% is the number of people with this deformity that appear at the age of 65. In the population of people over the age of 65, the percentage is slightly higher. It can even be found in professional literature up to 40 percent. ”
What is the main cause of bunions?
Dr. Zelimir Jovanovic: ” There are, of course, hereditary factors that we are born with. There are also factors that we can influence on. For example, footwear, body weight and the activities we do. ”
Footwear as one of the causes
Dr. Zelimir Jovanovic: ” If I said that we risk the health of our feet, for some fashion that we follow, maybe some people would misunderstand me. That is not, certainly, my intention. We must be aware that shoes that are narrow in the front part and high heels, lead to an increased pressure on the front part of the foot. This is one of the reasons for the development of this issued. Footwear must be high quality, comfortable, made of quality materials. The insole must provide adequate foot support. Our feet suffer a great load, which physiologically needs to be distributed to certain points. If we wear low-quality footwear, footwear that does not have an insole, then there are biomechanical changes that eventually result in deformities. The insole serves to absorb the shock of the foot and to distribute the forces that the foot suffers.
Orthopedic interventions of the feet, knees, hips, shoulders and ankles are performed at the Atlas Hospital within the Center for Arthroscopy and Sports Surgery and the Center for General Orthopedics and Traumatology.
When do bunions form?
Dr. Zelimir Jovanovic: ” Bunions deformity can occur at any time. It occurs in both children and adults. It also occurs in old age, except that the causes are not the same. In children, the most common causes are some syndromes, which include deformities and some systemic diseases. In old age, degenerative changes are something that would be the root cause. They are significantly more common in women, depending on the examined population. In some populations around 9: 1, in some even up to 15: 1 they occur more often in women. ”
The connection between the bunions and the spine
Dr. Zelimir Jovanovic: “There is no direct connection between the bunions, as an entity, and the problem of the spine. People who have problems with bunions, unconsciously change their gait pattern. They unconsciously change the way their foot sets on the ground when walking. Altered gait biomechanics can lead to a problem known as lower back pain. ”
Symptoms of bunions
Dr. Zelimir Jovanovic: ” Pain is the dominant symptom. In milder forms of deformity or deformity in the initial phase, the bunions may be asymptomatic. With the progression of that deformity, the difficulties or pains progress, all the way to the situation when they occur on both sides. Severe deformities can lead to a degree of disability. Patients rarely see a doctor or only when the deformity progresses. Then we don’t have a great choice of treatment, we can’t help them with a non-invasive method just right. The impression is that foot problems are not so important medical problem, as far as our population is concerned. Attention is more on degenerative diseases of large joints, trauma to large long bones and so on. ”
The foot is a complex assembly that consists of 26 bones, over 30 joints and 100 ligaments.
Influence of bunions on quality of life
Dr. Zelimir Jovanovic: ” A person who has serious problems can be prevented from performing normal life activities. Generally, the problems worsen with the colder months. In the period when we are forced to wear shoes every day, and if they are inadequate, then that leads to problems. ”
How much can alternative solutions help with bunion issue?
Dr. Zelimir Jovanovic: “I would stick to official medicine and official attitudes, which are supported by professional work and existing experiences. There are clear recommendations, when and at what point, how to treat bunions. ”
Dr. Zelimir Jovanovic: “The diagnosis of deformity is not difficult. It is necessary for the patient to contact an orthopedic surgery specialist, who will make a good clinical examination. The specialist will take the anamnesis and make an adequate X-ray of the foot. Based on that, a diagnosis can be made. ”
Bunions – progressive deformity
Dr. Zelimir Jovanovic: ” The deformity of the bunions is progressive. We don’t know how fast it will progress. There is research that in people who have a genetic load, the deformity will occur earlier and progress faster. ”
Degree of deformity
Dr. Zelimir Jovanovic: ” There are mild initial degrees of deformity, which give practically no symptoms. Then the deformity progresses to a very difficult condition, where the joint which is deformed becomes unusable, that is, completely destroyed. ”
Non-surgical or surgical treatment
Dr. Zelimir Jovanovic: ” Non-surgical treatment means a change in lifestyle. Patients should get rid of everything that causes them problems. This means correcting footwear, physical activity and weight loss. In addition to the above, there are orthopedic aids that can in some way alleviate the ailments. Analgesic therapy and physical therapy are some of the ways for non-invasive treatment.
Dr. Zelimir Jovanovic: ” The operation, the choice of surgical technique, depends on the degree of deformity and the patient’s wishes. There are over a hundred surgical techniques related to foot correction. Surgeons do what they are familiar with, most often using their techniques. In relation to the degree of deformity, there are techniques that involve only soft tissue correction, without intervention on the skeletal system. Then, as the deformity progresses, there are more complex bone surgeries that are performed at multiple levels. ”
When is surgery the only solution?
Dr. Zelimir Jovanovic: “We, surgeons, like to operate on everything. If we look at the X-ray, if we look at the result and follow the literature, then we can say that the sooner the operation is performed, the easier is the surgery for both the patient and the surgeon. Different surgical techniques are used. The better the results, the faster the patients recover. If you ask our professors, they will tell you that bunions should be operated only when they cause problems every day and completely change the patient’s lifestyle. My personal position is somewhere in between. I think every patient is an individual case. Individualization of the approach is very important. The patient should know what awaits him, in what way bunions are treated, what he can expect positively and what negatively. The patient should know what the possible complications are or what the outcomes may be. In an agreement with the patient, it should be decided whether to operate, when to operate, whether to wait or not. ”
What are the most common patient questions?
Dr. Zelimir Jovanovic: ” The most common questions are related to whether surgery must be performed and whether there is some other way. They are also interested in the period after which they can return to normal life activities. ”
Returning to life activities after surgery
Dr. Zelimir Jovanovic: ” It depends on the choice of surgical technique, it depends on the patient and his cooperation with the doctor. It often happens that patients who feel well after the operation, simply do not want to listen to the doctor’s advice. They don’t want to rest a little longer. They think they can start more serious activities and then pain, swelling and problems arise. In soft tissue surgeries, with the removal of sutures, patients begin a more serious recovery or rehabilitation. In cases when osteotomy is performed, bone cutting and correction on the bone apparatus, the bones require some time to heal in the good position in which we put them. After that, rehabilitation begins. It takes about 2-3 months for patients to return to normal life, without difficulty or with minimal difficulty. ”
Absolute rest or caution?
Dr. Zelimir Jovanovic: ” Patients are practically on their feet the next day, after the operation. It’s just that they don’t put pressure on the front part of the foot where the correction was made, but they rely on the heel. In the first postoperative period, it is desirable to rest, rest the leg to reduce swelling and take adequate therapy. ”
Anesthesia for bunions surgery
Dr. Zelimir Jovanovic: ” The decision on anesthesia is made by anesthesiologists. Bunions are operated under general anesthesia. There are new procedures, where the surgeon gives local anesthesia to the place where he operates. It is still innovative. The world has started working on this method, so we hope that in the near future we will be in a situation to operate bunions like tooth operation at the dentist office, under local anesthesia. I would advise you to decide with the anesthesiologist about the choice of anesthesia. ”
Is surgery a permanent solution?
Dr. Zelimir Jovanovic: “It is usually a permanent solution. During the operation, we try to correct everything that is needed. We try to maintain that position with certain implants or in some other way. Depending on how we decide, in relation to the case itself. I must say that there are situations when surgery is not a permanent solution, that is, when there are some complications. These complications can be banal, insignificant, and can be serious. We must certainly say that there is a situation when there is a recurrence of the disease. ”
How common are recurrences of bunions?
Dr. Zelimir Jovanovic: ” Recurrences are not frequent, but they still occur. There is a small percentage of relapses, but it certainly happens. ”
What can be done to really prevent problems with bunions?
Dr. Zelimir Jovanovic: “If we have in mind everything we said, because of which bunions can occur, then we should act accordingly. It does not necessarily mean that once you wear high-heeled shoes or narrow shoes in front, you will get a bunion. If it’s your lifestyle, then you have to be aware that you are at risk of deformity. ”
At the age of 10, I developed arthrosis on my fingers. Now it also occurs on my toes and makes them thicker. It happens when I walk for a long time it starts to hurt. What is the recommendation, since I know that arthrosis is not curable?
Dr. Zelimir Jovanovic: ” The patient first had a problem with her hands, and later that problem also appeared on her feet. It’s all reminiscent of a systemic disease that needs to be investigated. In any case, for some more detailed information, it would be best for the patient to come for an examination where we will determine that real issue. The patient said that they advised her not to treat arthrosis, I would not agree with that. There are ways in which they are treated, meaning both operatively and non-operatively. I think that there is a solution for the patient to at least reduce her problems, if not, to make her completely painless. Without a clinical examination and without some picture, I would not be able to say anything in detail. ”
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