2024 Tailors bunion.pptx

Mathew Johnstone DPM, FACFAS, D.ABPM TAILOR’S BUNION Assistant Professor CPMS Des Moines University LECTURE OBJECTIVES Recognize Recognize the radiographic findings associated with Tailor's bunions. Demonstrate Demonstrate knowledge of the biomechanical causes of Tailor's bunions Identify Identify t...

Mathew Johnstone DPM, FACFAS, D.ABPM TAILOR’S BUNION Assistant Professor CPMS Des Moines University LECTURE OBJECTIVES Recognize Recognize the radiographic findings associated with Tailor's bunions. Demonstrate Demonstrate knowledge of the biomechanical causes of Tailor's bunions Identify Identify the conservative and surgical treatment of Tailor’s bunion deformities, including the complications This presentation may contain copyrighted material used for educational purposes under the guidelines of Fair Use and the TEACH Act. It is intended only for use by students enrolled in this course. Reproduction or distribution is prohibited. Unauthorized use is a violation of the DMU Integrity Code and may also violate federal copyright protection laws COPYRIGHT NOTICE A painful prominence of the fifth metatarsal bone. Bunion- Some confusion  Latin- from Greek βούνῐον Meaning tuber, or turnip  Norse: Bunga ”bulge”  Middle English: bony “swelling” Anonymous 1780 “Interior of a tailor's shop” WHAT IS A TAILOR’S BUNION? The association with tailoring is centuries old. The tailor would sit crosslegged on the floor to work causing the lateral foot to rest upon the ground. CLINICAL PRESENTATION Prominence located on the fifth metatarsal head  Dorsally  Dorsolateral  Lateral  Plantar-lateral Usually seen with adductovarus fifth toe Shoe gear worsens pain by rubbing on the area May also be referred to as “bunionette” deformity CHIEF COMPLAINT EXAMPLE Can present with acute inflammation and exquisite pain  Redness  Localized swelling/pouchy texture  Increased skin temperature  Inflammatory reaction to shearing over the boney prominence  Adventitial bursa  Bursa: A fluid filled-sac formed as a direct response to repeated trauma/shear  Adventitia- outside covering of an organ (As opposed to anatomical synovial bursae and retrocalcaneal bursa) Structural  IM angle  Fifth metatarsal structure  Shape of fifth metatarsal head  Plantarflexed fifth ray Functional/biomechanical  Uncompensated/rigid forefoot deformity  Rigid rearfoot deformity with forefoot compensation  Hypermobile fifth ray ETIOLOGY TYPICAL STRUCTURAL FIFTH RAY DEFORMITIES: FALLAT AND BUCKHOLZ CLASSIFICATION A: Enlarged Metatarsal Head B: Increased 4/5 IM angle C: Increased fifth metatarsal lateral deviation angle (lateral bowing) The 5th metatarsal head either will not reach or will just reach the common transverse plane of the other meta-heads when the 5th ray is fully dorsiflexed Prominence of metatarsal-head is lateral or plantar-lateral  A normal 5th metatarsal declination angle is 10 degrees. STRUCTURAL DEFORMITY: PLANTARFLEXED 5 TH METATARSAL Pain/prominence are seen when declination angle> 10 degrees. Tailor’s bunion can be associated with a splayfoot deformity CONGENITAL STRUCTURAL DEFORMITY: SPLAYFOOT An IM angle > 12° between the 1st and 2nd metatarsals, and an IM angle > 8° between the 4th and 5th metatarsals FUNCTIONAL TAILOR'S BUNION: COMPENSATION Pain and increased lateral pressure when 5th metatarsal is forced into a dorsiflexed, abducted, and everted position by ground reaction forces Top image: uncompensated forefoot varus Bottom:  Compensated rearfoot varus  “get the foot to the ground” The 2nd and 3rd ray are relatively stable compared to the first and 5th respectively. Total excursion can be measured against these reference points. FUNCTIONAL TAILORS BUNION: 5 TH RAY HYPERMOBILITY A hypermobile 5th ray allows the foot to remain pronated for a longer period during gait. EVALUATION OF BUNIONETTE DEFORMITY Start with clinical features  Pain:  With Palpation?  With ROM?  In shoes? Vs without  Weight bearing? Vs non  Appearance (red/ swollen/ shiny)  Skin Temperature  Boney prominence vs bursal projection  Adducto-varus of the fifth toe?  Radiographs 5TH TOE ADDUCTOVARUS As the shaft of the 5th metatarsal everts, the abductor digiti quinti is placed more plantarly in relation to the 5th metatarsal bone  Thus, it loses it’s abductory force on the 5th toe, and the toe adducts and moves into varus Adductovarus deformity of 5th toe may produce joint changes at the 5th MPJ Stabilize the central rays and grasp the fifth metatarsal head (not the toe) Like measuring first ray ROM Normal 8.71° associated with tailor’s bunion Normal lat. Dev. 2.64-7.5° Lateral deviation angle of Fallat and Buckholz: > 8° is associated with Tailor’s bunion Normal