Clinical Bunion Eval and Treatment notes

Clinical Bunion Eval and Treatment notes - Clinical Bunion...

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Clinical Bunion Evaluation and Treatment Etiologies -biomechanical: abnormal mechanics of 1 st MPJ -structural: mal-alignment of hallux and/or met; abnormally long hallux and/or met -metabolic: inflammatory diseases (RA, gout) -traumatic: heals badly -congenital *shoes don’t cause bunions, but they aggravate bunions occurs at all ages (esp. 10-14 yrs) conservative care not so good Biomechanical Stages of HAV Stage I -normal osseous alignment -congruous 1 st MTPJ: joint space is symmetrical -functional hallux limitus: limited ROM at RCSP, normal ROM at NCSP -usually pt. abnormally pronates -orthotics useful Stage II -deviated 1 st MTPJ: joint space no longer congruous -abnormal HA angle -orthortics useful Stage III -abnormally high IM angle -orthortics useless Stage IV -subluxed 1 st MTPJ -orthortics useless Patient Goals/Expectations -position of hallux -return to work/drive car -return to all activities -return to wearing all shoe gear -elimination of ALL symptoms (4-6 months) -recurrence of deformity/complications Evaluation Steps -obtain good history of pathology -perform NWB exam -perform WB exam -evaluate patient’s gait -take appropriate radiographs
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Historical Information -description of symptoms -duration of symptoms -what produces symptoms -prior treatment -type of shoe gear worn -occupation/avocation NWB Exam 1. 1 st Ray Excursion: greater than 15 mm = hypermobility (Root’s and Hick’s Test) -Root’s Test: grab 1 st Met head; move up and down w/ thumb -Hick’s Test: dorsiflex hallux; perform Root’s Test a. if Root’s and Hick’s are both hypermobile then surgical tx b. if Root’s is hypermobile, but Hick’s is less than 15 mm then orthotics as tx (an orthotic will keep the 1 st ray stable) 2.1 st MTPJ -ROM: 65 degrees dorsiflexion for normal propulsion; plantarflexion usually 20 degrees (not necessarily important unless you’re a diver) a. draw long axis of proximal phalanx b. draw long axis of metatarsal c. dorsiflex/plantarflex hallux and measure -Quality of MTPJ Motion: painfree, pain, crepitus -Axis of Motion: motion of hallux in corrected vs. uncorrected position a. unrestricted: same movement b. tracking: same movement, but tension present; due to lateral soft tissue
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This note was uploaded on 04/19/2008 for the course PODIATRY Surgery taught by Professor Dr.gerbert during the Spring '08 term at Samuel Merritt.

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Clinical Bunion Eval and Treatment notes - Clinical Bunion...

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