American College of Foot and Ankle Surgeons Releases New Guidelines on Toe-Joint Disorders

PARK RIDGE, Ill. -- New clinical practice guidelines published in the current issue of the Journal of Foot & Ankle Surgery will help physicians advise patients about whether or not to consider foot surgery for conditions affecting the joint at the base of the big toe, including bunions, arthritis and problems caused by long-term stress and trauma to the area.

The new guidelines were developed by a panel of leading experts on forefoot conditions from the American College of Foot and Ankle Surgeons. They will help physicians and patients assess benefits and risks of various treatments and also select the type of surgical procedure that is most appropriate based on age, lifestyle and severity of the condition.

The first metatarsophalangeal joint (1st MTP) is the most complex joint of the foot, where bones, tendons and ligaments work together to transmit and distribute the body's weight, especially during movement.

"If the joint is painful and interferes with walking, physical activities and regular exercise, non-operative treatments should be considered first," said James Thomas, DPM, FACFAS, a co-author of the ACFAS guidelines and a podiatric foot and ankle surgeon in Birmingham, Ala. He added that the guidelines recommend that physicians should direct their patients to wear wider, low-heeled shoes, use bunion pads, apply ice and take over-the-counter analgesic medications. These initial options are designed to relieve pain and make it easier to walk and engage in physical activities, but they do not address the underlying cause of bunions.

"Bunions, however, are progressive, so if non-operative treatments bring little or no symptomatic improvement, surgical intervention should be considered. If the initial evaluation and treatment were performed by a primary care physician, the patient should be referred to a podiatric foot and ankle surgeon," Thomas explained.

Different surgical techniques are used at the discretion of the surgeon to achieve the desired correction. Determining which procedure is most appropriate for specific patients involves consideration of several factors, such as bunion severity, age, possible onset of arthritis and the desired level of physical activity a patient wants to achieve following surgery.

The ACFAS Clinical Practice Guidelines for Diagnosis and Treatment of 1st MTP Disorders are available to physicians at http://www.acfas.org/conditions.html .

Source: American College of Foot and Ankle Surgeons