The Prevalence and Impact of Chronic Foot Pain and Bunions
Chronic foot pain is epidemic in the United States with more than 40 million people complaining about pain in their feet. The deformity in the first metatarsophalangeal joint commonly called a bunion is the typical presentation of long-standing foot pain. More than half of the women in America have bunions, the American Academy of Orthopedic Surgeons has reported.
Understanding the Hallux Valgus Deformity
The term bunion refers to soft tissue swelling over the first metatarsal phalangeal joint associated with an abnormal angulation of the joint that results in a prominent first metatarsal head and overlapping of the 1st toe into the second toe, called the hallux valgus deformity. This is one of the most common causes of foot pain. Hallux valgus is a common condition estimated to affect as many as 23% of adults , and 35.7% in those older than 65. The etiology of hallux valgus is complex and multifactorial. Failure of the stabilizing soft tissue structures around the first metatarsal phalangeal joint may be a common cause of hallux valgus, furthermore high heeled shoes or typical narrowed tip toe box might induce deviations in both the proximal phalanx of the hallux and the first metatarsal bones. The deformity can often be attributed to ill-fitting shoes and sometimes there is a familial disposition. Women are much more commonly affected than men in a 15:1 ratio. It is generally accepted an imbalance of the extrinsic and intrinsic foot muscles and the ligament structures is involved in this disease. Hallux Valgus also appears to have a strong genetic predisposition. In a large Level IV study, 90% of patients with hallux valgus had a least one family member that was similarly affected. Other potential predisposing factors for hallux valgus include metatarsus adductus, first ray hypermobility, pes planus, equinus contracture, ligamentous laxity and increased length of the first metatarsal.
Anatomy of the First Metatarsophalangeal Joint and Bunion Formation
The first metatarsal phalangeal joint is a condyloid synovial juncture. The metatarso-sesamoid complex consists of the head of the first metatarsal, the base of the proximal phalanx, 6 muscles, 8 ligaments and two sesamoid bones. The base of the proximal phalanx is concave and has a large base to receive its muscular and ligamentous attachments. The ligaments of the joint are attached to the joint capsule by the medial and lateral collateral ligaments, the medial and lateral sesamoid ligaments, the plantar transverse metatarsal ligament, the inter sesamoid ligaments and the hood ligament. Bunion hallux valgus is a foot disfigurement that happens when the big toe angles toward the other toes. The shifting in the toe placement in space leads to the development of a bunion which is a bony projection on the medial side of the big toe attempting to stabilize the movement of the joint.
Diagnosis and Conservative Management of Hallux Valgus
Diagnosis is made by clinical examination and radiologic features clinically. The lateral deviation of the great toe is obvious when the patient stands barefoot and measuring hallux valgus angle radiographically A dorsal plantar radiograph with the foot under load is required. Initial treatment remains conservative with large toe box shoes, pain control, stretching, taping or spacers. When indicated, surgical treatment is controversial because of the greater than 150 described surgical procedures and a historically high prevalence of reoccurrence of bunions according to this statistic reported by the American Academy of Foot and Ankle Surgeons. Patients should use conservative treatments before surgical therapy and only patients with very severe pain or dysfunction and those whose symptoms do not improve under a conservative regimen should be referred to a foot surgeon.
Conventional Pain Management and Surgical Outcomes
Chronic pain due to bunion valgus deformity makes patients try different relieving available management methods. These include non-steroidal anti-inflammatory drugs, oral steroids, local steroid injections and physical therapy. Surgery is not always advised for bunion valgus hallux deformity. However, surgery for bunions is one of the most common orthopedic operations in western industrialized countries. Roughly 209,000 hallux valgus surgeries are done annually in the United States with high failure and recurrence rates.
Conservative Treatment Options
Physical Therapy can be used for stretching and strengthening intrinsic foot musculature and improving joint mobility. Footwear Modifications are typically the cornerstone of conservative therapy for this condition. These include shoe modification, toe spacers, night splints, and custom orthotics. These aim to alleviate pain and prevent progression rather than reverse the deformity. For bunion valgus, current clinical treatment methods like medications and local steroid injections carry the risk of potential side effects and other methods like reconstruction surgeries do not adequately heal this pathology and most likely will result in tissue scarring with further problems. Medications do not alter the bunion deformity.
Surgical Options and Complications
Surgery is commonplace when functional impairment is unresponsive to conservative treatment modalities. Over 150 surgical procedures have been described in the literature. They all aim to achieve soft tissue realignment and improve the joint arthrodesis. However, surgical repair has a high complication rate. Common surgical complications include: 30% reoccurrence of the deformity, nerve injury, infection, stiffness and loss of motion in the joint, non-union or malunion and transfer metatarsalgia. Complication rate and reoccurrence rates can be as high as 78% as reported in one study. The direct cost of these procedures are on average $5000 to $10,000 without post operative care or therapy.
Platelet Rich Plasma for Bunion Pain Relief and Tissue Regeneration
Platelet Rich Plasma is an autologous pain management method, popular presently in the orthopedic, rheumatology and sports medicine practices because of its effectiveness, low cost and safety. Platelet Rich Plasma attributes its therapeutic effectiveness in bunion deformity treatment because of its contribution in wound healing and the soft tissue repair process. This role can be explained by growth factors released from the alpha granules on the platelets which have regenerative properties. Tissue repair is a complicated mechanism in which there are many cellular functions such as chemotaxis, angiogenesis, cell proliferation and extracellular matrix formation. Platelet Rich Plasma has more than 1500 bio active proteins, like transforming growth factor beta, fibroblast growth factor and platelet derived growth factor which are vital for tissue healing. Platelet Rich Plasma, as a local injection in the management of hallux valgus deformity, serves as a chronic pain management method as it contains hundreds of growth factors that are responsible for its potential effects in reconstruction, regeneration and strengthening of the affected ligaments and soft tissues involved in a bunion valgus pathology. PRP is a safe, effective and cost-effective management method for chronic pain resulting from bunion hallux valgus and a means to regenerate the tissues involved.
Studies
Hallux Valgus
Foot Ankle Ortho 2019 May 7;4(2):2473011419838500 PMID 35097321
Adjusted Indirect and Mixed Comparisons of Conservative Treatments for Hallux Valgus: A Systematic Review and Network Meta-Analysis
Int J Res Public Health 2021 Apr 6;18(7):3841 PMID 33917568
Autologous Platelet Rich Plasma in Diabetes Foot Disease: A Meta-Analysis
J Diabetes Complications 2024 Feb;38(2):108690 PMID 38278034
From Platelet Rich Plasma to Mesenchymal Stem Cells: Cartilage, Tendon, and Bone Regeneration with Orthobiologics
Instr Course Lect 2024:73:3-13 PMID 38090881
Innovative Solutions from Juventix Regenerative Medical
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes that are critical for the regenerative process.
LED Activation and PRP Enhancement Technology
Juventix Regenerative Medical offers a patented LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of growth factors, cytokines and bioactive proteins from the granules that are contained on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation standards of the FDA. This activation should always be accomplished after the gentle swirl of the centrifuged product to maximize the number of captured platelets.
Shock Wave Therapy for Hallux Valgus Pain Relief
Juventix Regenerative Medical is proud to be a distributor of the PhysioPRO Shock Wave System. This clinical grade radial shock wave device induces intracellular and extracellular reactions to assist in the repair and regeneration of tissues. The wave activates cellular pathways that drive the healing process. Shock wave treatment stimulates angiogenesis and neogenesis. These metabolic processes form new blood vessels to better oxygenate damaged tissues and mediates repair. The shock waves also modulate and overload pain receptors to decrease pain. Treatments with the PhysioPRO can modulate mesenchymal stem cells to migrate to the damaged tissue area for enhanced cellular regeneration. The PhysioPRO augments Platelet Rich Plasma in the treatment of hallux valgus pain and deformity.
Comprehensive Regenerative Solutions from Juventix
Juventix Regenerative Medical has a vast array of products, devices and services tailored for the medical and regenerative professional. Platelet Rich Plasma Kits and the Physio Pro are two of the many devices that offer the latest treatments for the painful hallux valgus. With our premier line of products and support from our experienced staff, Juventix Regenerative Medical is poised to aid any professional in enhancing clinical outcomes, while increasing patient satisfaction.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
