Bunions: Signs and Symptoms

Bunions may present symptoms or it may go asymptomatic, or symptom-free at all. It presents big problems to the foot, especially when wearing shoes or walking around. Some symptoms are listed below.

Foot Pain
This is the most frequent symptom of a bunion, or a Hallux Vagus. It involves the affected area, especially when walking around or wearing unfitting shoes. It is relieved by rest. Persistent or intermittent pain may be felt.

Changes in the Big Toe
There is an enlargement in the base of the big toe. A bulging bump may also be felt in the outer area. There is also swelling, redness and a sore feeling around the big toe joint. Thickening of the skin at the base of the big toe may also be evident. The marked prominence of the medial aspect of the first metatarsophalangeal joint is the most apparent of all changes.

Corn and Callus Formation
Both corns and calluses form when the first and second toes overlap.
A corn is an area of hyperkeratosis (an overgrowth of a horny layer of epidermis) which is produced by an internal pressure due to the underlying bone that is prominent because of a congenital or acquired abnormality, commonly arthritis or an external pressure, such as ill-fitting shoes.

Calluses, on the other hand is a discretely thickened area of the skin that has been exposed to constant pressure or friction. It may be produced from flawed foot mechanics.
In acute bursitis, symptoms of reddish site, edema or swelling and tenderness of the affected site may be manifested.

Bunions (Hallux Vagus)
Hallux Vagus or Bunions is a deformity that is defined as an unnatural, bony hump that is formed at the base of the big toe where it joins to the foot. The big toe in most cases deviate towards the other toes, where it also pushes to the first metatarsal bone- the bone directly behind the big toe. Thus, a bunion in this case, is formed. Since these produce intense pain, they are easily vulnerable to excess friction and pressure and friction from shoes and could lead to the formation of calluses.

There are two classifications of Bunions. The first one is an acute bunion, which causes a very sharp, intense pain. It proceeds after a bursitis, which is a sudden outcropping of a fluid-filled sac. It could eventually progress into the second type, Hallux Vagus, where it is described a chronic yet pain-free deformity that includes a permanent stiffening of the bones.

Causes of Bunions
There are different factors that cause bunion formation, from preferences to personal factors.

Women are more predisposed to bunion than men, due to the different shoes that they wear that causes foot deformities.

Footwear Choices
After years of wearing tight, poorly fitted shoes such as high heels and shoes with pointed tips might also be a predisposing factor for bursitis. These kinds of shoes might give the foot an unusual shape. Ballet shoes by ballet dancers could also lead to bunions.

Genetic Factors
When a family member of a bloodline has experienced bunions, a person might be at risk to get one if he or she continues to wear ill-fitting foot gear. Congenital abnormalities of the foot bones may also be a predisposing factor.


Although bunions do not really require medical intervention, appropriate interventions must still be done to properly diagnose a bunion.
The foot specialist (podiatrist) might ask these questions as part of the assessment:

  1. If there is a persistent foot pain or pain in the big toe
  2. A bump on the joint of the big toe that can easily be seen
  3. If there is lessened movement in the big toe and foot
  4. If there are no shoes that fits the feet well

The foot anatomy is also examined for any obvious changes. Diagnostic aids such as X-ray or Radiographs of the foot are done to test the integrity of the joints in the affected area, and it confirms any deviations of bones from the normal, such as the great toe and the metatarsal bone. It is also effective for screening other disorders, such as Arthritis and Gout. X-ray films are also an excellent way of calculating proper toe alignment. These X-rays are taken in a standing (weight-bearing) and non-standing (lying) positions. The angles are measured in connection with the examination and the clinical impressions so surgery could be scheduled. Other examinations to be considered include an MRI and CT scan. Each of these tests has its own advantages and disadvantages in a case-to-case basis. Physical examinations may be included to check looseness of ligaments and tendons around the affected site.

Blood and other pre-operative tests may be done if a person is scheduled for surgery. These are useful in detecting infection in site and for any deviations from normal CBC values.

Knee Arthroscopic Surgery – Treatment

Treatments and Aftercare

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Ligament and Patellar Surgeries
In scenarios where there is knee displacement or severe damage of the ligaments, Arthroscopic surgery is done often with ligament grafting. It involves getting a tendon tissue to be utilized for grafting and for creating holes in the femur, tibia or in the two bones with a drill. For 6-8 weeks, the person who underwent surgery might need to utilize crutches. The surgeon or any orthopedic specialist would strongly suggest a strength rehabilitation course that could help regain knee strength and function. The patient could resume his or her sporting or any physical activity when the doctor says so, depending largely on the person’s size, age and overall health status. The physician would make a thorough assessment first before deciding that it’s time for the client to get back to activities of daily living.

Patellar surgeries offer 90% chance of avoiding a patellar dislocation, despite a feeling of pain and swelling post surgery. It greatly depends on the rehabilitation plan being handed out for the patient to adhere.

Lavage and Debridement Surgeries

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For a short period of time, the leg must be slightly elevated to facilitate drainage. While walking, a crutch or knee immobilizer adds up strength and assurance. Physical therapy is highly recommended. Presence of dislodged blood clots may happen when there is pain and swelling at surgical site.

Different alternatives could be tested when several factors and options don’t serve up well. One of which is a conservative treatment which stands for RICE, which was being endorsed by the American Association of Orthopedic Surgeons. The RICE method stands for the following:
R- Rest. Allowing the knee to rest induces faster ligament healing.
I – Ice. Apply ice at the site for 15-20 minutes.
C- Compression. Compress the site with by utilizing a brace or bandage.
E- Elevation. Elevate the knee if necessary. This is to facilitate drainage and reduce swelling.

For pain management in Arthritis cases, anti-inflammatory drugs, weight management and regular exercise could aid the knee as it builds up strength.

Knee Arthroscopic Surgery


A procedure performed in the knee-joint area, Knee Arthroscopic Surgery is involved in making a small incision in the skin to repair tissue injuries in bones, tissues and ligaments surrounding the knee and joint. By using an arthroscope, a small instrument used along a guiding lighted scope connected to a television screen. By creating three incisions in the knee, additional instruments could be placed inside. This surgery could be classified into minor and major procedures. The minor procedures involve flushing and lavage and debridement, which is the smoothing of bone surfaces and tissue fragments that are linked with Osteoarthritis. The major ones include realigning a dislocated knee and doing grafting operations of the ligaments.

Prior to surgery, an intensive examination must be done of the causes of trauma and pain that lead to the injury of the knee. A leaps and bounds adjustment have been made in arthroscopic surgeries which allows lesser time of recovery, less anesthesia administered and less incisions to be done.

The purpose of the surgery involves two general surgical classifications- first, an acute injury that destabilizes the knee and second, pain management for floating or displaced cartilage and rough bone. Acute injuries come about from traumatic injuries suffered by the knee tissues such as those suffered in sports accidents. This leads to unstable knees, knee dislocations and deficiency of knee mobility. Pain management surgeries alleviate discomforts of the knee due to Osteoarthritis. As the name itself suggests, it relieves pain and discomfort in the knee area mostly caused by chronic conditions and uses elective surgical procedures to treat bone and cartilage surfaces.

Mostly done in an outpatient setting, Knee Arthroscopic Surgeries are done usually under a General Anesthesia, Spinal or Epidural, a regional block or local anesthetic are also sometimes being used. Surgery could commence if enough anesthesia is being administered. An IV Line is tagged upon admission for fluid administration. After surgery, sterile dressings are placed over the incision site while a Brace Wrap is placed in the region surrounding the joint.

Arthroscopic Surgery for Acute Injuries
The knee stabilizes itself with the help of four ligaments, namely the Anterior and Posterior Cruciate Ligaments (ACL/PCL) and the Medial and Lateral Collateral Ligaments (MCL/LCL). When one of these ligaments is torn by means of trauma or sports injury, the knee “buckles”, or it gives way. These ligaments will also make the knee track an unusual direction rather than its normal movement. Multiple tears in knee ligaments would also lead to more repairs done in the affected knee.

Patello-Femoral Syndrome (PFS)
A patient’s patella without a good support might cause it to be shaky and agonizingly painful when you move. Chronic problems might arise in people with proper patella tracking in the femoral area. It is linked to conditions that include foot pronation or if not by just simply overusing the muscles. As the patella is moved, examination can be done by the physician around the surrounding cartilage that has increasing friction. The ease of movement is increased by smoothing the damaged cartilage which in turn gets rid of pain. A tendon can make the patella track off the center part of the femur. With lateral release surgery, the patella is enforced back in its usual movements.

Pain Management
Arthroscopic Knee Surgeries could also treat a torn Meniscus, a cartilage resembling the shape of a crescent which pads the knee. Without this internal knee cushion, it could result to extreme pain. Although it could happen in sport-related injuries, it is more evident in Osteoarthritis and Rheumatoid Arthritis. A Lavage and Debridement is a procedure in which the surgeon flushes out floating or displaced tissue pieces. Then the bone surface is smoothened and leveled to decrease the amount of pain.

Diagnosis and Preparation

Knee injuries are more common in athletes who play contact sports and to elder people due to the decreased function of the knees, the ones who carries most of the body’s weight. Diagnosing knee injuries or damage contains a Physical Examination, X-rays and more thorough diagnostic imagery examinations such as CT scan and MRI. If clients experience intense knee pain, then they consult a physician, which decides if that entails for an operation and rehabilitation after it.

Arthroscopic Surgery is a bloodless surgery and it also presents lesser complications. The patient’s underlying condition is one reliable factor if he/she is eligible to go for an Arthroscopic procedure. Another important thing to consider to consider is the level of the person’s tolerance to the anesthetic being used. Lung and heart functions should be ideal for the procedure, including conditions such as Heart Failure, High Blood Pressure and Diabetes Mellitus. Some contraindicated medications should also be withdrawn, such as anticoagulants or blood thinners.

Physical Examinations, Blood Tests and Urine samples are taken prior to the surgery as part of the evaluation during the pre-operative phase. Patients 50 years old and above who are experiencing heart and lung problems have to obtain an ECG result together with a Chest X-Ray. If the body is experiencing signs of infection, the surgical procedure is immediately cancelled unless results reveal a possible joint infection. After the two hours surgery, the patient is required to rest until anesthetic effects are cleared out. Most outpatient surgeries instruct the person who underwent Arthroscopic Knee Surgery to avoid driving and doing activities that require mental stimulation. If follow-up visits are to be done, it is made a week after when the dressings placed could be thrown off. the dressings are removed.

Surgical Surgery Rehabilitation

Rehabilitation after spine surgery is necessary to help patients gain the most benefit from their surgery. Initially, rehabilitation is helpful for patients to recover from the surgery as quickly and effectively as possible. A physical therapist typically work with the patient to help him get back into better physical condition.

  1. Controlling Pain after Spine Surgery- A physical therapist will help manage pain after spine surgery. Pain control is a necessary step to allow patients to regain strength. The physical therapist many use various means to help alleviate pain and this may include certain spine positions, ice application, some types of movements and electrical devices like TENS unit.
  2. Recovery Exercises after Spine Surgery- A spine surgery patient can have better recovery with exercises. Exercise is the key to removing fatigue and staying away from re-injury. A physical therapist is expected to create an exercise programs that are tailored to particular patients based on information of the precise type of spine surgery and the factors that are advantageous for the spine of the patient under several conditions.
  3. Training Program after Spine Surgery- The physical therapist will make a training program for the particular patient while considering specific surgery, body tissue conditions and body types. He should focus on facilitating muscles in areas where a special training may be needed by the muscles to gain strength and give stability after the spine surgery.  Individualized physical therapy may be helpful also for areas where the flexibility and mobility of the patient has been restricted by spine surgery.

Spine Surgery

Spine Surgery

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Spine surgery is a rare initial treatment for back pain but there are some emergencies that are likely to require surgical treatment. In majority of patients, such surgery is considered after a long course of traditional and conservative therapy. As back pain usually takes some time to resolve, rushing to spine surgery may not be the perfect idea. Usually, doctors recommend at least 3 to 6 months of conservative treatment before taking into account spine surgery. There are various types of spine surgery and these include:

  1. Spine Fusion- This is a surgery that is performed to associate together individual vertebrae within the spine. When the vertebrae have a problem, the doctor may advise this procedure to eradicate the movement that exists within that area of the spine.
  2. Lumbar disc replacement- This procedure is considered by doctors as unsafe compared to cervical disc replacement surgery. This is a new treatment option for some types of low back pain.
  3. Lumbar discectomy- A discectomy is a procedure that involves the removal of a herniated disc from the spinal canal that causes the nerve pressure. A certain fragment of the normal spinal disc is expected to be dislodged when a disc herniation exists.
  4. Foramenotomy- This is performed to relieve nerve pressure by pinching the nerve with more than just herniated disc. This procedure removes a part of the bone and some tissues that compress the nerve as it gets out from the spinal column.
  5. Laminectomy- This is performed to relieve spinal cord pressure. This is usually used to treat conditions like spondylolisthesis and spinal stenosis.

Spine Surgery Risks and Complications
Complications of spine surgery are always a risk and this must be considered carefully before deciding to have a surgical procedure.

Risks of Local Anesthetics- There are a lot of spine surgeries that are done under local anesthetic. This involves performing the whole procedure amid consciousness of the patient. Local anesthetic enables surgeries to be performed with less risk of paralysis.

Risks of General Anesthetic- General anesthetic involves the performance of a surgical procedure while the patient is unconscious. There a few patients who are allergic to some anesthetics. In rare cases, a patient can go into anaphylactic shock or even die. It is likely for general anesthetic to cause lung problems. It may lead to pulmonary infections and even pneumonia. This anesthetic increases heart attack risks as well as embolism and stroke.

Infections/Complications of Spine Surgery– Any surgical procedure carries a risk. Some infections might occur in the skin or in some deeper level of the wounds created during the surgery. A procedure that utilizes bone grafts out of a cadaver to reinforce a fusion is very prone to infections. When the spinal canal is infected, the patient will become sick or even die.

Spinal Fluid Leaks-There is a possibility of a dural tear in any procedures done within the spine. A leak will occur when there is a membrane puncture or rupture that covers the spinal cord. Though most leaks of spinal fluid can be corrected, those that are not corrected need an additional corrective surgery.

Nerve Damage-Nerve damage may cause a decreased sensation and body movement which may affect the functioning of the heart and lungs as well.

Paralysis-This is a major spine surgery risk. This may happen when a spinal cord injury is infected.

Failed Back or Spine Surgery Information

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Failed back surgery is the condition that involves prolonged and continued pain experienced by the patient after surgery. There are a lot of reasons that a spine surgery may or may not work even with the hands of the best surgeons. Despite best indications, spine surgery is still over 95% predictive of a successful result. Basically, the accomplishment of a spine surgery just includes decompression of a pinched nerve root and stabilization of a joint in pain. Other reasons for failed spine surgery include:

  1. Inadequate nerve root decompression
  2. Implant failure
  3. Surgical nerve damage
  4. Preoperative nerve damage
  5. Lesion transfer failure
  6. Epidural fibrosis
  7. Postoperative rehabilitation
  8. Recurrence of spinal stenosis or disc herniation

Postsurgical Pain Predictability
Some forms of spine surgery are more predictable when it comes to reducing the symptoms of patients than others. For example:

  1. A spinal instability spine fusion is a predictable procedure. But, a multi-level lumbar degenerative disc disease fusion surgery may not be successful in alleviating pain after surgery.
  2. A lumbar disc herniation discectomy that causes leg pain is also predictable. However, a lumbar disc herniation discectomy that causes lower back pain may not be successful.

This makes it important to stick to highly successful operations to ensure preoperative identification of an anatomic lesion that is to be corrected during the surgery.
Furthermore, failed spine surgery can be treated by a combination of selective endoscopic discectomy, laser disc decompression, intradiscal infiltration, differential provocative discography and intraforaminal steroids infiltration.

Next, visit the Spine Surgery Center of Excellence, a site devoted entirely to spine surgery and spine treatments. 


Local therapies such as Surgery and radiation therapy only remove cancer cells in the area that has been treated. Chemotherapy is a systemic therapy since it has the potential to kill cancer cells found in any part of the body.

Medical Treatments
Radiation Therapy
A high-energy ray-like radiation can get rid of cancer cells and normal cells on its path. Oftentimes, it has been used as an alternative treatment for surgery. External Radiation is produced by a machine outside the person’s body. The treatment is done for 5 days in a span of 5-7 weeks. Internal Radiation, on the other hand could be given through a small radioactive material which could be inserted via the urethral opening or creating an abdominal incision. The pellet could be removed by the time treatment is complete. The consequence of radiation therapy is that it kills some normal cells, so the patient might experience more general body symptoms such as weakened immune defenses and fatigue.


Chemotherapy involves the use of medications to get rid of cancer cells. It could be  administered along with radiation therapy, surgery or with the combination of the two. Unfortunately, chemotherapy gives the person some unpleasing side effects. The side effects experienced vary on the drug or combination of drugs being used and the frequency of chemotherapy sessions, or the person’s exposure to the chemotherapeutic agents. These side effects also depend on the person if he/she could tolerate the medications or not. The most common side effects experienced are nausea, vomiting, appetite loss, falling off of hair (alopecia) and weakness or fatigue.

Other therapies such as biological therapy could be recommended.
Surgical operations are the most used treatments for bladder cancer. The operation for the person depends on the stage and grade of tumor. The common surgeries for bladder cancer are as follows:

• Transurethral Resection of the Bladder (TURP)
In this surgical operation, an instrument is placed in the urethra and is pushed into the bladder. The tumor is removed through a small wire loop on the instrument’s other end by means of cutting or burning.

• Radical Cystectomy
This one involves removing the whole urinary bladder organ along with the lymph nodes surrounding the area; this is done to prevent metastasis of cancer cells to other organs, especially the vital ones. Partial cystectomy only involves removing a part of the bladder.