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What to do with Bunions?

What to do with Bunions? Better to leave them alone.

A bunion is a characteristically large bony bump at the base of the big toe. This alters the alignment of the bones, causing the base of the big toe to angle out and crowding the tops towards the smaller toes. Bunions can often be painful and cause swelling, making it difficult to find comfortably fitting shoes. The big toe pushing against the smaller toes can result in irritation of the skin, forming painful calluses.

Bunions occur more frequently in women and can occur in children as well. Although some footwear can contribute to the deformity, it is not the sole cause. “People who develop bunions often have an underlying predisposition to acquire them, such as a family member who may have them, overly mobile joints, or a disease such as rheumatoid arthritis,” explains Dr A Holly Johnson, Foot & Ankle Surgeon at the Massachusetts General Hospital and Instructor at Harvard Medical School, Boston, MA. Traumatic injuries to feet or toes can also result in bunions. Bunions can occur in people with flatfeet (or over pronation) and may involve deformities of the smaller toes, such as hammer toes.

xray of normal foot (left) and a foot with a bunion (right) hallux valgus
Left: X-ray of normal foot while standing. Right: Foot with a bunion, also called hallux valgus. Notice the bony protuberance and the large angle at the base of the big toe. The top of the big toe is seen crowding towards the smaller toes.
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Mark Vrahas: Total Hip Arthroplasty for Acetabular Fractures

Total Hip Arthroplasty for Acetabular Fractures
Mark Vrahas, MD
Partners Chief of Orthopaedic Trauma, Department of Orthopaedic Surgery,
Massachusetts General Hospital, Harvard Medical School
Boston, MA.

Grand Rounds presented on October 15th, 2009 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA.


Please leave a comment to let us know what you think.

Holly Johnson: Diagnosis and Treatment of Peroneal Tendon Pathology

Diagnosis and Treatment of Peroneal Tendon Pathology
A Holly Johnson, MD
Foot & Ankle Service, Department of Orthopaedic Surgery,
Massachusetts General Hospital, Harvard Medical School
Boston, MA.

Grand Rounds presented on September 24th, 2009 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA.


Please leave a comment to let us know what you think.

Grand Rounds: Cervical Deformity Correction

Cervical Deformity Correction
Daniel Riew, MD
Professor & Chief, Cervical Spine Surgery
Washington University School of Medicine,
St Louis, MO

Grand Rounds presented on September 17th 2009 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA


Please leave a comment to let us know what you think.

Grand Rounds: Hip Pain in the Young

Hip Pain in the Young
Peter Asnis, MD
Orthopaedic Sports Medicine
Massachusetts General Hospital, Harvard Medical School,
Boston, MA

Grand Rounds presented on November 26th 2008 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA

Dr Asnis reviews the diagnosis and treatment of hip pain in young patients. He goes over the physical exam and an appropriate radiographic work-up. The differential diagnosis for hip pain in the young is discussed. The treatment algorithm for several common problems is outlined. Special attention is paid to the treatment of labral tears and femoroacetabular impingement.


Rotator Cuff Disease

Primary Cause of Shoulder Pain and Treatment Options.

There are several causes of shoulder pain. In the elderly, shoulder pain is commonly associated with aging and can be traced to rotator cuff disease. In younger people, it is associated with throwing or overhead sporting activities that result in injury to the rotator cuff.

rotator cuff anatomy

The rotator cuff is a band of four muscles and tendons at the shoulder joint, which grasp the end of the upper arm or humerus (HYU-mer-us, see figure), much like four fingers holding a baseball. The rotator cuff thus stabilizes the shoulder joint and provides exceptional mobility to the arm. Pinching, irritation, or tears of the rotator cuff are common causes of shoulder pain.

shoulder rotator cuff anatomy holding baseball

Impingement
Rotator cuff tendons are separated from overlying bones by a soft tissue sac or bursa, allowing them to glide easily. According to one theory, repetitive motion of the arm causes pinching of this sac in the tight space between the acromion (a-KRO-me-un) and humerus (see figure), resulting in irritation, swelling and pain. This inflammation of the bursa and tendons is called impingement. The pain is characteristically worse when the arm is lifted and common at night.

Causes and Symptoms
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