2010年5月28日 星期五

大拇指外翻 hallus valgus



大家如果有留意新聞
應該知道前個排Victoria Beckham
都因為Hallus Valgus要做手術
唔可以著佢既至愛 --> high heels
maybe we should talk about hallus valgus today

(information mainly from Current Rheumatology Diagnosis & Treatment by William Jenkin)

History:

Most likely results from the combination of a biomechanical fault, constrictive footgear, and walking on hard surfaces

Physical Examination:

standing position: observe the degree of deformity 畸形狀態 of the great toe and lesser toes. the overall posture of the foot is noted. look for lateral deviation 偏向
of the great toe / medial bunion

gait: looking for evidence of abnormal ground contact or early heel rise, which would indicate possible tightness of the Achilles tendon 腳跟.

seated position: the ROM of the ankle, subtalar, transverse tarsal, and metatarsophalangeal joints is noted. The plantar aspect of the foot is examined for abnormal callus formation, particularly beneath the metatarsal head and along the medial aspect of the great toe.


The neurovascular status of the foot is carefully assessed, noting venous stasis changes. Doppler studies are obtained if there is any question regarding the circulatory status of the foot.

x-ray findings


Treatment:

Non-operative

The patient should be encouraged to wear shoes of adequate size and shape. This simple form of management may relieve most symptoms.

Pads may be placed in the first web space or over the median eminence to help take pressure off a painful median eminence. Pads are also available that can be placed underneath the metatarsal heads to take pressure off painful calluses or sesamoids.

If after adequate conservative management the patient continues to have discomfort, surgical intervention may be considered. Surgery is not performed for cosmetic reasons or to allow patients to wear fashionable shoes, but rather to correct a symptomatic structural deformity.

Juvenile hallux valgus deformity presents a significant problem in management, but as a general rule, conservative management should be continued until growth is completed, after which surgery may be considered. Extra care must be taken into consideration in the juvenile population where cosmetic appearance may play a greater role in the patient's or parents' desire for surgery.

Hallux valgus surgery is generally contraindicated in high-performance athletes or dancers until they are no longer able to perform at the level necessary to continue in their vocation or avocation. Premature surgery in these individuals may diminish their special abilities.

Surgery (only mentioned the most common one)

Distal Soft-Tissue Procedure



The procedure requires releasing the soft-tissue contracture on the lateral side of the metatarsophalangeal joint, including the lateral joint capsule, the adductor hallucis tendon, and the transverse metatarsal ligament.

On the medial side of the metatarsophalangeal joint, the medial eminence is removed 2–3 mm medial to the sagittal sulcus and in line with the medial aspect of the metatarsal shaft. The capsule on the medial side of the joint is plicated to hold the toe in correct alignment.

Postoperatively, the patient is maintained in a firm compression dressing, which is changed on a weekly basis for 8 weeks. During this period, the patient is permitted to ambulate in a postoperative shoe.

沒有留言:

張貼留言