Bunion Workup

Updated: Apr 05, 2016
  • Author: Richard T Laughlin, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Workup

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 metatarsophalangeal joints (MTPJs), a rheumatoid factor level 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 count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), can be ordered to rule out infection. [26] Arthrocentesis is most valuable in helping to evaluate for infection. [26]

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Imaging Studies

A standing foot radiograph in the anteroposterior (AP) and lateral planes is mandatory in determining the type of surgery needed for bunion correction. [27] In additional, an oblique nonstanding film can be obtained to gain a different perspective of the metatarsal head and hindfoot. A sesamoid view, though 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. (See the images below.)

Severe bunion deformity. Severe bunion deformity.
Fifty-year-old woman with bilateral severe hallux Fifty-year-old woman with bilateral severe hallux valgus deformity.

Although it is generally accepted that treatment decisions for hallux valgus (HV) are based on plain weightbearing radiographs, a study by Burg et al suggested that treatment strategies can also be confidently determined on the basis of nonweightbearing radiographs. [28] In this study, 21 expert and ankle surgeons evaluated 10 random clinic patients with HV by measuring the HV angle (HVA), the intermetatarsal (IM) angle (IMA), and the distal metatarsal articular angle (DMAA); they then used that information to make an intervention recommendation.

No statistically significant difference was detected in the angles measured. [28] In terms of surgical procedures chosen, the distal osteotomy was chosen 10.8 times in the weightbearing group and 11.2 times in the nonweightbearing group. No differences were observed in the preferred surgical treatments chosen by the surgeons. A relative weakness of the study was the lack of clinical evaluation of the patient's foot before the choice of an intervention.

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