Hope for hallux valgus
One of the most frustrating things about managing a patient with hallux valgus—or being one—is that so often the emphasis is on the negative. But new research suggests clinicians’ advice to patients with bunions could be much more than just telling them what not to wear.
In a study published in the November issue of Medicine, Spanish researchers found that the thickness and cross sectional area of the abductor hallucis and the flexor hallucis brevis muscles were significantly smaller in the feet of 10 patients with hallux valgus than in the feet of 10 controls.
Similar studies have identified intrinsic foot muscle atrophy in patients with a range of other foot conditions, and have motivated clinicians to consider intrinsic strengthening exercises to help alleviate symptoms and potentially delay disease progression (see “Importance of intrinsic muscles for foot health,” June 2016, page 15).
It’s far too early to say whether intrinsic strengthening in patients with hallux valgus might help stave off corrective surgery or even reverse the condition’s progress, or whether such interventions might be more effective in certain patient subgroups than in others.
But we know the ability to wear fashionable shoes is a priority for many women with hallux valgus (see “Most women who want to wear heels after bunion surgery do so,” page 6), even when warned that high heels and tight toe boxes will make their symptoms worse.
This highly motivated patient population, while notoriously noncompliant when it comes to what not to wear, might well be responsive to the suggestion that intrinsic strengthening exercises could allow them to more comfortably indulge in less-sensible styles, at least occasionally.
And I’m sure clinicians would welcome the chance to be more positive when advising hallux valgus patients. Because having to say no all the time is almost as frustrating as having to hear it.
By Jordana Bieze Foster
But many still experience discomfort – Most women who want to return to wearing high heels after hallux valgus surgery do so, but may sacrifice comfort for style, according to research from the University of Manchester in the UK. Clinicians in the US say many of the study’s findings—although not all—are consistent with their experience.
By Emily Delzell
Device wear delays braking response – A recently published study from the Temple University School of Podiatric Medicine in Philadelphia bolsters previous research suggesting that wearing a lower extremity immobilization device on the right foot could negatively affect driving performance.
By Lori Roniger
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By Howard Kashefsky, DPM
Typical interventions in patients with active diabetic foot ulcers include offloading devices and a decrease in activity. And an increasing number of tools are becoming available to help lower extremity clinicians determine how well their patients are actually adhering to such interventions.
By Cary Groner
Foot health experts say that, overall, women are less enthusiastic about high-heeled shoes and smarter about wearing them in moderation. But those who still feel the need to wear heels in professional or social situations can benefit from clinicians’ advice and, at times, footwear modifications.
By Lori Roniger
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