Thursday, April 19, 2018
Bunions and sex: Whatever next ?
Wendy Perriam is an English novelist, nothing unusual in that but her literary works, Tread Softly, won the author the dubious honour of the Literary Review's Bad Sex in Fiction award. This was the third time she had been put forward. Previous winners have been Alan Titchmarsh, Melvyn Bragg and Sebastian Faulks, so she is in good company. What clinched her the accolade was a scene in ‘Tread Softly’ where the intrepid heroine, a 30-something convalesce, recovering from a bunion operation, with complications, makes love to her husband whilst fantasizing about her foot surgeon. Convent-educated Perriam attributed her love of explicit scenes to her strict religious upbringing. Apparently the author did not receive sex education at home or school and has been fascinated with the subject ever since. But I ask myself does that excuse bringing bunions into the sex equation. Nothing more strange than folk.
Operations to the old bunions are very common and a patient satisfaction survey from the American College of Foot and Ankle Surgeons would support over 90% of patients experienced significant pain relief (96%), increased their physical activity (92%), and would recommend the procedure (89%). These findings reflect other findings from the UK and elsewhere. To the uninitiated, bunions describe a bursitis (inflamed fluid filled sac) which appears on the inside of the big toe joint. Swells up when agitated by friction usually from shoes which have less volume than the anatomy of the foot would require. The condition can become more pronounced if the metatarsal bone slips its ligament attachment causing the head of the bone to protrude. Then the condition is referred to as Hallux Abducto-Valgus, which is often mistakenly called ‘bunions’. The situation becomes more complex with osteoarthritis of the big toe joint and often suppuration (inflection) of the fluid filled sac is another compounding factor.
In any event bunions or HAV can be very painful, inhibit normal walking, and make it difficult to fit the feet into some shoes. Contrary to popular belief, bunions are aggravated, not caused, by tight shoes. Hallux Abducto Valgus is due to faulty rear foot mechanics which place intolerable stress on the main pivotal joint on the forefoot. Pain is the primary reason people seek medical attention with the majority of bunion surgeries historically performed on women. This is more to do with their skeletal make up than any demonization of fashion shoes, per se.
Despite reported post-surgical success conditions do apply and other studies have shown long term outcomes support a high return of HAV after surgical intervention. This is easily explained because the cause of the deformity relates to rearfoot patho-mechanics, which are often ignored at the expense of the orthopaedic procedure. The overall good news is patients seldom are troubled with the reoccurrence of their bunions and there are several theories as to why this is the case. By far my favourite is the condition is cured with the first operation and re-occurrence is not registered. Out of sight out of mind.
In truth, asymptomatic hallux abducto valgus is probably more natural to the functioning foot than we give it credit and out idealized straight toe joint is as unnatural as Lara Croft is to the perfect figure.