Bunion of the toe

Bursitis of the toe or in other words the inflammation of the joint bag is one of the most common diseases of the musculoskeletal system.

The internal cavity of the joint is lined with a special shell that produces a fluid that provides painless and easy movement in the joint articulation. Because of various infections and changes, the cavity of the first joint of the metatarsophalangeal region becomes inflamed, which leads to a violation of its direct function and restriction of motor activity.

In medical practice, there was an opinion that the big toe bursitis develops in those individuals who consume large amounts of salt, but in later studies this hypothesis was not confirmed. However, situations where the articular bag is inflamed due to salt deposits are not that rare. For example, this phenomenon is common in gout, when salt joints of uric acid are deposited in the phalanges of the feet. Also, inflammation can develop and when the function of immunity, or more specifically, rheumatism, rheumatoid arthritis, psoriasis. However, the main cause of the disease is valgus deformity of the feet. This is observed when wearing uncomfortable, narrowed shoes, flat feet, muscle pathology and leg ligaments, most often this disease occurs in women.

[1], [2], [3]

Causes of bursitis of the big toe

The causes of bursitis of the big toe are varied, but the main factor provoking the inflammatory process is the excessive accumulation of fluid in the joint bag. Normally, this fluid is in the cavity of each joint, it is due to its properties that every movement in the joint occurs smoothly. In addition, the pressure on the bone also decreases, making movements in the joint painless. If for some reason the liquid in the bag of the joint begins to accumulate in large quantities, this leads to the development of the inflammatory process. In case of chronic inflammation and traumatism, compaction is formed in the joint bag. Over time, because of this compaction, the bone moves, because of this, a cone is formed at the site of the articular articulation.

Causes that increase the risk of inflammation of the synovial bag can be classified as follows:

• Because of flat feet.
• With hypermobility of the joint, mainly occurs with its weakness.
• In diseases of the musculoskeletal system, for example - arthritis.
• With chronic trauma or long unhealing trauma to the thumb of the foot.
• With congenital deformity of the foot.
• With infections of the joint cavity.
• With disturbed metabolism.
• With allergies.
• Because of intoxication.
• Inflammation of surrounding tissues.

To avoid bursitis of the big toe, it is worthwhile to think about the timely prevention of this disease - to monitor the way of life, nutrition, wear comfortable shoes, especially if you have to stand on your feet.

[4], [5]

Symptoms of bursitis of the big toe

Symptoms of bursitis of the big toe are usually difficult to confuse with other diseases of the musculoskeletal system. The first signs of inflammation of the bag of the joint are:

• Deformation of the thumb of the foot, formation in the joint joint area.
• The appearance of pain in the area of the joint of the thumb, which increases with walking.
• Discomfort and pain when wearing shoes.
• Creation of callus on joint articulation.
• Impaired sensation in the area of the big toe.

The first signs of the disease are difficult to ignore, largely due to this inflammation of the synovial bag can be determined at the initial stage. To clarify the diagnosis at the initial stage will help a specialist, since the inflammation of the articular bag may be similar to arthritis, gout, cerebral palsy, multiple sclerosis, etc. At an early stage of the formation of painful densification, it is possible to stop the development of the disease and restore the joint's work and with timely access to a specialist and competent complex therapy can achieve full recovery. Otherwise, the inflammatory process will lead to the development of arthrosis and complete ossification of the articulation, and, accordingly, deformities of the foot.

Purulent bursitis of the big toe

This acute inflammatory disease, covering the entire cavity of the joint bag. The joint bag or synovial bag is a cavity that surrounds the joint head; inside the cavity there is a small amount of a special fluid that contributes to the normal painless movement in the joint, due to which the friction between the bone, muscle tissue and ligaments is reduced.

Articular fluid can become infected for several reasons - if it gets into the pathogens of infection through the blood and lymph, as well as through the wound channel of the joint bag (with tears, dissection, gunshot wound, surgical intervention, etc.). But a particular danger is the presence of foci of purulent inflammation near the joint articulations, namely:

• purulent arthritis;
• furunculosis;
• erysipelatous inflammation;
• subcutaneous phlegmon, etc.

The most frequent pathogens of inflammation of the synovial bag - streptococci and staphylococcus, less frequent cases of infection with E. Coli, etc.,

Purulent bursitis of the thumb is dangerous because during the inflammatory process in the joint cavity there is a purulent melting of the walls of the joint cavity and purulent exudate penetrates into the tissues, which leads to such complication as the phlegmon of the foot. This is an acute surgical disease requiring urgent surgery and complex antibacterial therapy. With the timely access to the doctor and the observance of medical prescriptions, the joint function is restored quickly.

Diagnostic of bursitis of the big toe

Diagnosis of the bursitis of the big toe is carried out according to the data of the patient's questionnaire, in the later stages there is enough data of examination and palpation - the presence of valgus deformity can be noted with the naked eye. But it is also important to perform an X-ray examination of the affected joint to determine the extent of deformity and the condition of the adjacent foot bone system.

Such methods as CT and ultrasound are prescribed as an additional method of diagnosis when there is a suspicion of the presence of adjacent pathologies of the musculoskeletal system. In addition, a clinical and biochemical blood test is mandatory. With their help, you can get accurate information about the condition of blood cells that are very sensitive to inflammation and other changes in the body, as well as get information about the state of organs and systems of the human body.

Diagnostic confirmation of the diagnosis should be started as soon as possible. At an early stage, the disease can be completely eradicated, restoring the functionality of the joint. Diagnosis at a later stage complicates further treatment, but with all the rules and the corresponding orthopedic treatment, the outcome of the disease is favorable.

[6]

Treatment of bursitis of the big toe

Treatment of bursitis of the big toe can be both conservative and operative (with purulent bursitis and in those cases when very severe pain occurs when walking). Treatment of this disease in the competence of traumatologist-orthopedist, surgeon. The effectiveness of treatment depends on the timing of contact with a doctor. Acute bursitis is treated out-patient, and complicated chronic bursitis requires treatment in a hospital.

• In case of severe pain in the patient's joint, it is necessary to fix the diseased joint (with the help of a bandage, any latch), apply a sachet of ice or snow through the material to the affected joint, bandage the foot with an elastic bandage, and keep the limb with a raised one, placing the foot on the pillow.
• To prevent complications of acute inflammation, anti-inflammatory and pain medications are prescribed (Ibuprofen, Diclofenac, Naise, Analgin, Butadion, Ketoral, etc.). With purulent bursitis, antibacterial agents are prescribed, but only after the bacterial sowing of the articular fluid and detection of the pathogen.
• In the acute phase, physiotherapeutic procedures are prescribed, UHF.

In the chronic form of inflammation of the synovial bag, surgical intervention is indicated. The surgeon dissects the articular bag, removes the adhesions and outgrowths inside it, after which the cavity is washed with an antiseptic solution, antibiotics, anti-inflammatory and anesthetic preparations are prescribed in parallel. The process of restoring movements in the joint can take several months.

Operation for bursa of the big toe

Operation with bunion of the big toe is carried out in those cases when other treatment options were unsuccessful, pain in the joint does not allow full movement or there is a persistent deformation of the foot, which prevents walking. Also, the operation is prescribed in cases when the disease passes into a chronic form.

Before the operation, the doctor assesses the patient's general physical condition, leg condition, radiographic findings, venous and arterial blood circulation. Also it is necessary to take into account possible complications, which may be followed by a postoperative period. This development of tumors, infections, the emergence of bleeding, the displacement or shortening of the toe, the re-development of inflammation. The risk group includes patients who have poor health, insufficient or excessive diet, diabetes, smoking or alcohol abuse.

Before the operation, either general anesthesia or local anesthesia is given, depending on the complexity of the patient's condition. After anesthesia, the doctor dissects the joint bag near the big toe. Then part of the phalanx is removed (conducting an osteotomy), its head is formed so that the phalanx is in the correct position. In severe cases, the phalanx is fixed with pins from surgical steel to maintain and form the bone. After that the wound is sutured and a bandage is applied on it. In general, the operation lasts 30-120 minutes, depending on the complexity of the case.

Operation for bursitis of the big toe gives the ability to restore mobility in the joint and reduce pain when walking. Complete recovery occurs 8 weeks after surgery.

Prevention of bursitis of the big toe

Prevention of bursitis of the big toe touches almost everyone - in pursuit of fashion shoes, not everyone cares about its convenience. Shoes with heels, shoes with a narrowed toe, with frequent wearing, promotes deformation of the bones of the foot. The pressure on the joint of the thumb is constantly maintained, which leads to the formation of callosity and changes in the position of the phalanx. In the future, the displacement prevents walking, there is a very strong pain in the foot, the joint.

To prevent the development of bursitis of the big toe, you need to choose comfortable shoes, especially if you have to spend a lot of time in the standing position. In extreme cases, have a replacement set of shoes with a wide toe. It is also useful to do foot massage, in particular massage the joint of the thumb. If the fact of inflammation is confirmed, then it is necessary to immediately abandon the narrow shoes and wear a special fixator-gasket. The retainer is placed between the first and second fingers, which does not allow the first phalange to change position and makes the load on the joint bag much less, and also reduces pain during walking.

Prevention of bursitis of the big toe and timely detection of it allows early control of the further development of the disease, and relieve surgical intervention.

Forecast of bursitis of the big toe

The prognosis of the bursitis of the big toe with timely diagnosis and treatment is favorable, but at a later date, when the valgus deformity is already formed. This is dangerous because a complication such as arthritis can develop, and this will lead to a restriction of the joint and pain during movement. Arthritis leads to disruption of gait and posture, and this will lead to inflammation of the overlying joints. In case of infection of synovial fluid through the wound channel in the articular articulation area and the development of purulent bursitis, the recovery process takes longer, since surgery will be required.

In severe forms of bursitis of the big toe, the foot is guided by osteotomy - bone reconstruction of the foot bones, aimed at changing the position of the bone of the metatarsus and phalanx of the first finger. But this is an extreme method of treatment when other treatment options are ineffective.

It is possible to rely on the foot of the foot for the third week after the operation, and the restoration of motor functions comes in 6-8 weeks. During 8-12 weeks the process of complete recovery is completed, but we must not forget about preventive measures - wear comfortable shoes with a wide toe, use special fixatives and orthopedic insoles.

[7], [8], [9]