Bunion Workup

  • Author: Richard T Laughlin, MD; Chief Editor: Jason H Calhoun, MD, FACS   more...
 
Updated: Feb 17, 2012
 

Laboratory Studies

In general, specific laboratory studies are unnecessary. However, it behooves the surgeon to be aware of subtleties. For example, if small, punched-out lesions are noted around the articular surfaces, a uric acid level may help rule out gout. If symmetrical narrowing is appreciated in the MTP joints, a rheumatoid factor may be helpful in ruling out rheumatoid arthritis. Finally, if there is any appearance, either clinically or radiographically, of infection, laboratory work, including complete blood cell (CBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), can be ordered to rule out infection.[17] Arthrocentesis is most valuable in helping to evaluate for infection.[17]

Next

Imaging Studies

A standing foot radiograph is mandatory in the AP and lateral planes when determining the type of surgery needed for bunion correction.[18] In additional, an oblique, nonstanding film is usually obtained to gain a different perspective of the metatarsal head and hindfoot. A sesamoid view, although seldom necessary, also should be obtained if a special problem with the sesamoids (eg, fracture or avascular necrosis) appears to be present. This information is then combined with the clinical picture in order to determine the best surgical procedure for the patient.

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Contributor Information and Disclosures
Author

Richard T Laughlin, MD  Professor and Chair, Department of Orthopedic Surgery, Sports Medicine and Rehabilitation, Wright State University Boonshoft School of Medicine; Co-Director, Foot and Ankle Care Center, Active Staff, Miami Valley Hospital

Richard T Laughlin, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Mid-America Orthopaedic Association, and Orthopaedic Trauma Association

Disclosure: AOFAS Grant/research funds None; Ohio Third Frontier Grant/research funds None; Wright State University Boonshoft School of Medicine Seed Grant Grant/research funds None; AOFAS None Post Grad Education Committee; Dayton Area Graduate Medical Education Consortium (DAGMEC) None Member; Mid-America Orthopaedic Association None Education Committee; South Surgery Center, LLC Consulting; Wright State Physicians, Inc. None Board membership; Wright State University Boonshoft School of Medicine None Executive Committee; AO North America Honoraria Speaking and teaching

Coauthor(s)

Emmanuel K Konstantakos, MD  Resident Physician, Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Miami Valley Hospital, Wright State University, Boonshoft School of Medicine

Disclosure: Nothing to disclose.

G Ryan Rieser, MD  Resident Physician, Department of Orthopedic Surgery, Miami Valley Hospital, Wright State University, Boonshoft School of Medicine

G Ryan Rieser, MD is a member of the following medical societies: Student National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James K DeOrio, MD  Associate Professor of Orthopedic Surgery, Duke University School of Medicine

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Foot and Ankle Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Shepard R Hurwitz, MD  Executive Director, American Board of Orthopaedic Surgery

Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS  Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

Additional Contributors

Kyle L Randall, MD Resident Physician, Department of Orthopedics, Medical College of Wisconsin

Disclosure: Nothing to disclose.

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Distal metatarsal articular angle (normal < 10°, average in normal feet 7°).
Proximal phalangeal articular angle (normal < 10°). This deformity is within the proximal phalanx.
Congruent joint.
Noncongruent joint.
Hallux valgus angle (normal < 15°), intermetatarsal angle (normal < 9°).
High proximal phalangeal articular angle in proximal phalanx.
Akin proximal phalanx closing-wedge osteotomy to correct high proximal phalangeal articular angle.
Moderate bunion deformity with an intermetatarsal angle of 14° and a hallux valgus angle of 28°.
Distal chevron metatarsal osteotomy fixed with a Kirschner wire.
Severe bunion deformity (intermetatarsal angle 16°), with elevated proximal phalangeal articular angle.
Proximal chevron osteotomy fixed with 2 screws. Note Akin proximal phalanx osteotomy fixed with Kirschner wires and hammertoe correction held with Kirschner wire.
Proximal chevron osteotomy fixed with 2 screws.
A 70-year-old woman with rheumatoid arthritis and severe bunion deformity. First-toe metatarsophalangeal fusion preoperative image (top) and 2 years' postoperative image (bottom).
A 22-year-old woman with hypermobile first ray, first and second intermetatarsal angle of 18°. Lapidus procedure preoperative image (left) and 6 months' postoperative image (right).
Table. Categories of Hallux Valgus Deformity
AngleMild SubluxationModerate SubluxationSevere Subluxation
HVA< 20°20°-40°>40°
1-2 IMA< 11°< 15°>15°
Sesamoid< 50°50-75%>75%
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