Bunions: Cause & Treatments

Bunions are bony humps that form at the base of the big toe. When this happens, the big toe will curve towards the other toes and cause the base of the toe to push towards the first metatarsal bone. It usually occurs at a joint and the entire body weight will be acting on it. This will result in tremendous pain and discomfort.

Causes

As we grow and develop, more pressure is acting on the foot due to the need to support the body’s entire weight. Therefore, it gets worse as age increases. Bunions is hereditary and will run in the family due to the fact that foot type and shape is hereditary. In some cases, bunions will develop with existing medical conditions such as arthritis. Women are also at a higher risk of suffering from bunions due to the fact that most women wear tight and ill-fitting high heeled shoes, pushing the foot bone into awkward positions for long periods of time.

Non-surgical treatment

Non-surgical is targeted to reduce pressure on the big toe and provide pain relief.

  • Wearing wide and comfortable shoes with sufficient space for toes to wriggle. The insoles should also provide good arch support.
  • Custom made orthotics will help to distribute the body’s weight equally throughout the foot and reduce any unnecessary pressure acting on the big toe.
  • Pain relief medication will provide instant pain relief for patients and bring down the swelling.
  • Ice is a cheap and effective method to reduce swelling and provide pain relief.

Surgical treatment

If non-surgical treatment does not provide adequate pain relief, daily activities such as walking can be severely hindered. In such cases, surgery may be the only option left. The main aim of bunion surgery is to straighten the curved toe bone and provide pain relief.

  • Bunionectomy is a bunion specific surgery and involves removal of part of the affected metatarsal head.
  • Osteotomy involves the cutting of bones located in the toe to prevent bone spurs from sticking out and re-alignment the soft tissues around the toe joint.
  • Resection arthroplasty is reserved for more serious cases and involve the removal of bone located at the end of the first metatarsal joining the metatarsophalangeal joint.

As the saying goes, prevention is better than cure. A good pair of footwear is often all that is needed to prevent one from getting bunions. Selecting a pair of functional shoes over one that is aesthetically pleasing is a much sensible choice.

Lisfranc (Midfoot) Injury: Cause & Treatments

Lisfranc or midfoot injuries are often the results of broken bones in the midfoot or torn ligaments. Lisfranc injuries can vary from complex to simple depending on the number of joints and bones that are involved. Many patients often mistaken their midfoot injury to that of a simple sprain. As a result, many choose to self-medicate with pain relief cream. However, Lisfranc injury is not as simple as it seems and may even require surgery in some cases.

Located in the midfoot are clusters of small bones forming an arch at the top of the foot. There are five long metatarsal bones extending to the tones and ligaments and tendons hold the bones in place. However, there are no connective tissues holding the first metatarsal to the second metatarsal.

Lisfranc injuries can occur due to either direct or indirect trauma. Direct trauma is often result of an external force striking the foot while an indirect trauma occurs due to a force transferring to the stationary foot that deforms the foot. The foot is a smart system that is divided into three different sections namely the hindfoot, midfoot and forefoot. The role of the midfoot is to translate force and provide rotational stability and it is the keystone for plantar flexion and dorsiflexion. Therefore with a lack of dorsal support, the load acting on the foot is sufficient to cause dorsal displacement, leading to broken bones and/or ligaments.

The earlier a Lisfranc joint injury is diagnosed, the better it is for both patient and doctor. An initial clinical evaluation involving radiographs such as x-rays and MRI will be performed to indicate the probability of a mild, moderate or complex sprain. If diastasis is not present, immobilisation will be needed. This will include the usage of an immobilisation cast for a period of four to six weeks followed by limited movements. After six weeks, rehabilitation exercises need to start immediately. This is due to the bone being a piezoelectric material and will resorb after periods of inactivity.

If surgery is needed, it will be performed within 24 hours of the injury or after 10 days to allow for the drainage of bodily fluid due to swelling. Kirshner wires will be used to fix the bones together and bone fragments will be removed. After surgery, patients need to be immobilised in a cast for up to 12 weeks with minimal movements.

Some people will no longer be able to return to pre-injury levels of activity after a midfoot injury despite advancement in medical technology.

 

How Do I Know If I Need Hip Replacement Surgery?

Hip replacement surgery is not something that everyone needs. However due to certain medical conditions such as osteoarthritis, hip replacement surgery may be the only way to get back a good quality of life. The choice is still ultimately up to you on whether to undergo hip replacement surgery or to take pain relief medication to tide you through. Let’s discuss on how you know if you really need surgery.

Unbearable pain and stiff hips

When pain gets unbearable and hips are always stiff, simple actions such as climbing the stairs, walking and even standing can be extremely difficult. Pain relief medication can only help you to overcome pain for certain duration and cannot be used forever. Therefore, when your osteoarthritis is this bad, hip replacement surgery is the only option available for you in order to get back a good quality life.

Bone damages

Due to osteoarthritis, bones are damaged and the bones are unable to regenerate and grow again. The joint cartilages are also disintegrated and no form of medication or physical therapy can help to repair it. When damages to the bone happen, hip replacement surgery will be required to repair it.

Alternative treatments failed

Surgery will usually be the last option that your surgeon will consider. Usually, he will prescribe you pain relief medication followed by physical therapy in order to help you regain flexibility in your joints and strengthen the surrounding muscles. However when all these treatments fail, surgery will be the only option left.

Conditions with no known cure

Rheumatoid arthritis is an auto-immune disease where the body’s immune system attacks the joint mistakenly instead of protecting it. The body does not recognise it as its own and treats it as something foreign and will continuously attack it until it is no longer there. There is no known cure for rheumatoid arthritis yet and patients who suffer from it must undergo hip replacement surgery in order to recover.

Above are 4 common scenarios where a hip replacement surgery needs to be considered. There are many factors that must be considered prior to surgery such as the age of the patient, overall health condition and bone density. Attempts to try alternatives to surgery such as medication and physical therapy will be made before suggesting surgery. Hip replacement surgery is a major and costly procedure and careful thought must be made before a final decision is made.

Hand Fracture and Aftercare Instructions

In our hand are 5 bones which connect the wrist to the thumbs and fingers. These are the metacarpal bones and they are located between the phalanges and carpus bones. When one of these bones breaks, it is classified as a hand fracture and a splint or cast is often required to be worn whilst the bones heal on their own. For serious cases, surgery may be required to surgically reconnect and mend them using cement. In this article, we will be looking at the causes of fracture as well as the aftercare instructions for them.

Although our bones have good compressive strength, it has poor tensile strength. When sufficient force is applied, the bone can fracture and when this occurs, it is accompanied by pain, swelling and the inability to utilise it. A cast or splint will usually be placed in order to immobilise the hand as well as to prevent any unwanted stresses while it heals. In order to make the pain more bearable, your doctor will prescribe pain relief medication to be taken orally. Since this medication requires some time before it works, you should take it before the previous one wears off in order to prevent feeling any unwanted pain. In cases where inflammation is present, antibiotics will need to be consumed in order to treat the infection caused by bacteria. Always make sure that medication is taken on time to prevent any gaps in the recovery process.

When you are at home, you can apply an ice pack to the fractured portion of your hand. Icing helps to decrease inflammation and the pain associated with it. It also constricts the blood vessels and help to speed up the delivery of essential nutrients required for healing. It also reduces tissue damages to the sensitive parts. However, always remember to remove your cast or splint prior to the application of ice as the cast and splint cannot get wet. In order to regain finger movement in the shortest time, you should try to work out your fingers. A hand grip is great for building up hand strength and muscle and you can use it anywhere.

Hand fractures will usually require between 4 to 6 weeks for it to fully heal, but it will take an even longer time for you to regain full strength. In order to reduce this timeframe, you should make use of any possible time to gain those muscles.

4 Ways on How to Relieve Hip Pain

The hip joint is essentially a ball and socket joint that is designed to provide a near unrestricted range of motion and withstand this cyclic process and the wear and tear it brings along. Due to the frequency of usage, the hip joint can break down easily. The soft tissues located in the hip will be overused and injuries such as fractures and sprains can then happen, leading to hip pain. We will discuss about some ways to relieve hip pain in this article.

Stretching exercises

Stretching exercises help to keep the target group muscles warm and flexible. Exercises will increase blood flow to the area, bringing more nutrients such as oxygen and aiding repair works. Hip exercises such as bridging can help to relief hip pain. You simply have to lie down on your back and raise your butt off the ground while contracting your abs muscle. Hold in this position for 10 seconds and repeat for 3 sets.

Aquatic therapy

The main benefit of aquatic therapy is the reduced stresses acting on the injured joints. As the name suggests, it takes place in the water. Aqua therapy uses the unique buoyancy of water properties to assist in healing, conditioning and strengthening of the joints, allowing patients to perform the therapy in a painless manner yet significantly aiding the recovery plan. The viscosity properties of water allow a gentle resistance to build up the body’s mechanism.

Medication

During sudden onset of hip pain, pain relief medication is able to produce a temporal solution to counter the problem and allow patients to relax. Medication can only be a stop gap measure as it does not solve the root of the problem and that can only be solved by exercises, physical therapy or surgery.

Ice packs

Ice packs help to bring down swelling and calm irritated nerves and tissues in the hip region. Ice also contracts the blood vessels, reducing the amount of blood flow in the region. This will help to produce a temporary pain relief effect similar to medication but the effective duration is shorter.

Discussed above are 4 ways to help reduce hip pain. Hip pain is inevitable at some point in our lives due to the wear and tear of the cartilage lining. Joint supplements may be able to help alleviate the pain to a certain extent and is best taken when you are still young and active.

Questions To Ask Before Orthopaedic Surgery

Orthopaedic surgeries are major surgeries and are extremely stressful. There will be a lot of doubts going through your head and can trigger an anxiety breakdown. However, this can be controlled by asking questions prior to your surgery. Being knowledgeable about what you are about to go through will allow you to appreciate the entire surgical process, prepare yourself for it and set in mind a proper recovery plan post surgery. So what are some questions that you should be asking your surgeon before surgery?

Why am I doing this surgery?

It is easy to Google online for information regarding the particular surgery you are about to undergo. However, there is no clear answer to why you are doing the surgery. You should be asking your surgeon why he recommended this particular surgery for you and are there any other alternative treatment methods that are available as well as a comparison between the possible alternatives. This will allow you to have a high confidence level prior to surgery.

What are the risks?

Risks are inevitable in any surgery and some carry a higher risk level than others. It would be good to clarify on this issue as well as question about some surgical procedures which have lesser risk level such as the use of a local anaesthesia as compared to a general anaesthesia as studies have shown that patients who received general anaesthesia have a higher risk of post surgery bleeding.

What are the available pain relief methods?

Pain and discomfort is also unavoidable post surgery and some people have a lower pain threshold than others. Therefore, it is crucial to understand about the available pain relief methods which will help you get through this tough period. You should also know what medications you are allergic to so that proper medication can be administered to you.

What are the success rates?

Bluntly speaking, you undergo surgery with the hope that it is a success. However, as you have already known, some surgeries carry a higher risk factor than others and therefore the success rates will fluctuate. Knowing what the success rates are will allow you to make better plans for your future.

No matter what orthopaedic surgery you are about to undergo, you should always ask questions prior to it to clarify your doubts and set your mind at ease. Here’s wishing you to a successful surgery and quick post-surgery recovery.

4 Misconceptions About Epidural Steroid Injections

Epidural Steroid Injections (ESI) is commonly administered to patients suffering from lower back or leg pain. Lower back pain is due to the inflammation of spinal nerves, causing pain and discomfort to patients as the nerve passage is narrower compared to healthy patients. Corticosteroids are extremely strong pain relief medication that is injected directly into the area of concern, providing immediate relief. However, most patients undergo the procedure with the mentality that they will be “cured” from their lower back pain. This is a misconception of it and in fact, there are many more misconceptions out there about ESI.

ESI is extremely safe

Well, this is a misconception although it is true to a certain extent. Many people think that steroid injections are much safer than oral consumption of steroids. However, this really depends on the medication that is prescribed as the toxicity differs. While oral consumption of medication may cause irritation to the stomach and with the fact that it “travels” a longer distance down, there is a higher risk of allergy. However, ESI are injected directly into the affected area and when something bad occurs, it happens immediately without providing you much reaction time.

Repeated treatments are required for visible results

Many doctors tell their patients that a minimum of 3 ESI is required before they are effective. However, this is the average value comprising data from hundreds of thousands of patients worldwide. In fact, the exact amount of dosage required by each patient is never the same due to the differing genetics of each of us. Some patients get immediate relief after just a single injection while some may need a lot more to see results.

Multiple invasive sites are required

Most of us would have visited the hospital for one reason or another and a high percentage of us have had multiple needles injected into us. ESI are totally different from your usual invasive treatments. Only a single needle is required to be injected as ESI is done under the guidance of an X-Ray machine, providing the doctor with the exact spot to inject.

Immediate pain relief is obtained

While you may get immediate pain relief from the compressing of spinal nerves, you may suffer temporary pain in the form of bruises and tenderness due to the injection. Although the technique is conducted under the guide of an x-ray machine, human error is bound to happen. Bruising and swelling will go away on its own in just a couple of days.

Epidural Steroid Injections have been performed for a long time and it has a track record of being rather safe and successful. Since the procedure is an outpatient one, patients do not need to spend a night in the hospital, making it much more flexible and economical for them.

4 Exercises for Back Pain Relief

Relief from back pain can be obtained from simple back exercises that helps to stretch, loosen and strengthen the back muscles. Our body is designed in a way that the back muscles must work in tandem with the spinal cord and the soft tissues such as the ligaments and tendons. If there are any restriction to the movement, it will cause discomfort and pain for the patient. Back pain is an orthopaedic condition that requires special attention to be given to it. There are some good exercises that can help to provide pain relief and let’s discuss them below.

Myofascial Release

Lie down on a gym mat or on your bed depending on your comfort level as different surfaces will provide different level of pressure. Lay on one side of your body and place an exercise ball beneath it. The ball should be positioned at the muscular region at the side of the spine and slowly place your entire body weight onto the exercise ball. Do not attempt to move about or bounce up and down.

Forward stretch on a chair

Sit down on a chair that does not have any rollers. Place both of your feet firmly on the ground and sit upright. Slowly start to lean forward and stretch towards your toes while keeping your neck in a relaxed position. When you feel tightness in your back, hold in that position for 15 seconds and slowly return to the original position. Repeat this exercise for 10 times and whenever you can throughout the day. This will help to stretch and relax the back muscles.

Knees to chest

Lie down on a soft surface such as a gym mat or on your bed. Maintain a straight posture and slowly bring both of your knees towards your chest. You should be able to feel tightness in your back and hold in that position for 15 seconds. Repeat this exercise for 10 times and whenever you can throughout the day. This will help to stretch and relax the back muscles.

Piriformis stretch

Strong gluteus muscles can help to better support the body’s weight and take some load off the spinal cord. The piriformis muscles is at the buttock region and if the muscles are weak, it can cause pain in the lower back. Lie down on a soft surface and place one leg over the other and pull towards your stomach. You will be able to feel a tightening sensation at the buttock region and hold for 15 seconds. Slowly return to the starting position and change legs. Repeat this exercise for 20 times.

Exercises will help to stretch and strengthen the back muscles to provide pain relief. Most exercises require minimal space and can be performed throughout the day whenever you are free. Do not attempt to stretch beyond your limits and remember not to over exert the injured muscles.

Basic First Aid for Fractured Lower Limbs

Our bones have high compressive strength but poor tensile strength. This means that it can take forces acting on it in a compressive manner. However, it will crack or break if high impact forces are acted on it suddenly. Our bones also store essential minerals such as calcium and will release to the body when it detects a calcium deficit. A fracture is an orthopaedic condition that is hard to diagnose without proper radiography methods and when a fracture is suspected, it should be treated as a fracture unless otherwise diagnosed. Green stick fractures are partially broken bones and it is a partial fracture while a complete fracture occurs when the bone is snapped into two pieces. A compound fracture is indicative by a protrusion of the fractured bone through the skin. Immediate first aid should be administered to it.

Remove items on the injured area

The first thing that should be done is the removal of items around the injured area. If an ankle fracture is suspected, the shoes and socks should be removed immediately. This is because the ankle will start to swell up immediately and the longer the delay is, the more swollen it will be. This will lead to difficulties in removing the shoes later. If the injured person is wearing jeans, you will need to cut open the bottom of the jeans to allow excess space.

Stop the bleeding and disinfect the wound

Attempt to stop the bleeding using sterile gauze. Use disinfectants such as hydrogen peroxide, antiseptic creams or iodine to cleanse the area and if there is foreign debris, it should be rinsed under water. If bone protrusion or awkward bone locations are observed, you should not attempt to move the patient or it may lead to more serious complications.

Immobilise the patient

You can immobilise the patient using items that are nearby. Things such as ski poles, rods, thick tree branches can be used to superimpose them on the inside and outside of the leg. The main reason behind this is to prevent any further movements of the injured part and minimise further tissue damages. Whenever possible, always try to get them onto a stretcher.

Ice pack

After you have done the above steps, use ice packs to bring down the swelling and reduce inflammation. This will help to reduce pain and make things more bearable. If it appears too serious, you should seek medical help for the patient immediately.

Above is some of the basic first aid for fractured lower limbs. If the fracture appears mild, medical help is often not required. To further reduce swelling, pain relief medication can be taken orally.

Microdiscectomy Spine Surgery or Physiotherapy?

Located in our spine are intervertebral discs who acts as the cushioning system for the spine. It helps to balance the forces experience by the spine through actions like standing, jumping, lifting and sitting. It also helps to protect the vertebrae and brain by limiting the amount of movement allowed by each individual disc. Repeated actions over time can cause the disc to weaken and sudden impact or trauma can cause shearing of the discs, resulting in the semi-liquid substances to impinge onto the nerves, causing pain. When things get more serious, daily actions such as bowel and bladder control may not be possible and thus, surgery is often recommended by doctors. However, should you really consider surgery or other options like physiotherapy?

Microdiscectomy

During microdiscectomy, a small part of the bone is removed to create a space between the vertebrae which helps to relieve internal pressure, reduce pain and relieve neural impingement. As a small piece of bone is removed, it will not cause any instability issues with it. Neural impingement can cause pain in places such as the leg and after microdisectomy, an almost instant relief can be felt by the patient. As with all spine injury, there is a certain risk level. It is often the last resort as no surgery is 100% risk free. Unless patients suffer from bowel and bladder incontinence or other neural problems, doctors will not recommend surgery and will often suggest physiotherapy to try to find a solution to the problem. However, risk level is still generally low compared to other forms of surgery.

Physiotherapy

Physiotherapy is one of the options doctors will recommend initially together with pain relief medication. Physiotherapy is non-invasive, relatively safe and helps to strengthen the muscles in the body. Through stabilisation and strengthening exercises, some patients are able to find relief and are able to continue to lead a good quality lifestyle without surgery. Strong muscles are able to help take on some of the burden from the spine and distribute the weight much more evenly, reducing the stresses placed on the spine and reducing pain. Even if surgery is required after physiotherapy, it helps to reduce the recovery time as physiotherapy helps to keep them in a tip top condition and with strong muscles and body functions, they are able to recover faster.

When you suffer from spinal pain, you should consider going for physiotherapy first. There is always a chance that you can recover and lead a pain free life without surgery. However, only when things start to become more serious should you consider surgery.