Thursday, June 28, 2007

Posh's Bunions: Spice girl becomes slice girl

When the wife of former England captain, David Beckham was spotted hobbling around Madrid last year with painful-looking bunions protruding through her sandals the eyes of the world fell to Victoria’s feet. The foot police were quick to condemn the Spice Girl as a slave to fashion and victim of high heels. Mrs Beckham had confided in friends her bunions were giving her gyp and she was looking to have something done. Victoria revealed, “I hate my feet, they are the most disgusting thing about me. Part of the reason I wear such amazing shoes is to take the eye away from my horrid feet and on to the stunning shoes.” Sore feet are no fun and people living with aching ‘plates of meat’ usually get little sympathy, so lets hope the high profile Essex Girl can champion the foot weary, if for only a short while.

Does my bunion look big in these sandals ?

A bunion is an inflamed fluid filled sac which lies superficial to the skin surface over a bony joint. The fluid filled sac is called a bursa and helps protect vulnerable parts of the body, sometimes these arise naturally and others from shearing stress across the joint. Excess and prolonged damage from friction aggravates the bursa and an inflammatory response results causing the sac to become hot, red and swollen with pain a common symptom. Rest will reverse the process but if the situation continues then the condition becomes chronic with permanent colour changes. Ironically the chronic condition is rarely painful but complications do arise in the joint beneath and osteoarthritis (arthritis) causes joints to fuse which can become very painful, especially in the acute stages. Joint limitation hastens deterioration and when this is in the presence of systemic disorders such as rheumatoid disease or gout, then the condition can become extremely painful. A bursa can be removed by a simple surgical procedure but re-occurrence is likely especially when friction continues. The cause of bursitis is friction and shear between the skin surface and any resistance i.e. usually from part of the shoe. Ill fitting footwear should be avoided if a bursitis is to be avoided. A closer examination of Posh’s pre surgery feet would support the lady did not have bunions. She did however exhibit classic hallux abducto valgus (used to be known as hallux valgus). The hallux or big toe is made up of two phalanges which are joined at a joint that usually fuses (painless) with age. The position of the hallux gives critical information about the function of the ball of the foot and in particular the main pivot of the body. When it is deviated as in hallux abducto-valgus the big toe slants toward the outside of her foot (over the smaller toes) and this is an abducted position; the position of the great toe nail confirms a longitudinal twist of the great toe with base of the toe facing the outside of the foot (the nail is tilted toward the inside), this fixed plane rotation is called a valgus position. Even closer scrutiny reveals the big toe of each foot sticks up (dorsi flexed) from the rest of the bones. Together these movements represent three planes of motion (triplane motion) across a joint which has naturally only two free planes of movement available to it. This can only arise if the joint between the big toe and the ball of the foot is partially dislocated (subluxated). Ninety per cent of bi peds have to some degree a partial dislocation of their big toe joints all their lives and to that effect hallux abducto valgus is more normal than most people realise. However when subluxation arises with destructive wear and tear on the joint surfaces the condition becomes very painful and often requires surgical intervention. For most people who suffer painful HAV they have inherited the bone structures which predisposes them to the condition. Trauma and or disease will occasionally account for disarticulation of the big toe but shoes are rarely the primary cause although they may excite a bunion. There are over a 130 different operations that can be undertaken to deal with hallux valgus, many of which involve cutting the bone (prominence), where ever possible however greatest emphasis is given to preserving joint continuity and the function of the foot subsequently reconstructive surgery has made many advances. The available published studies seem to indicate reoccurrence of HAV is high post surgery but patient satisfaction surveys appear to show client s are very happy with their new feet. Preventing HAV is literally impossible albeit exercises and foot orthoses including shoes are popular. In the US there is an internet talk show called Life After Bunions, where who knows we may see Mrs Beckham in the near future. My only advice to her apart from take a rest is do not tell Tom Cruise a close friend of the Beckhams and podophobe) you have had foot surgery.

1 comment:

Anonymous said...

very amusing, but good information on bunions and their treatment.

Dr. Marc Mitnick