Page 134 - ASOP ROT Study Guide

Occasionally there may be an infection of the bursa. This results in a tense swelling associated with
infection of the skin (cellulitis) and general ill health (malaise).

Chronic bursae with no symptoms are benign and need no treatment unless the patient demands it either
for convenience or appearance. For instance, the swellings may interfere with dressing. If tender they may
be excised, although the patient should be encouraged to remove the underlying cause (for example by
using a kneeling mat).

Infected bursae should be incised and drained as this often leads to a spontaneous recovery through
scarring and fibrosis.

14. ADULT FOOT DISORDERS

14 . 1 Introduction

Abnormalities of the feet are relatively common in the western world and this must relate in many ways to
our shodden state. Also, our perceptions of abnormality are very varied, as varied in fact as our feet. The
only foot abnormalities that matter are those which cause symptoms - usually of pain. Treatment or
surgery is seldom, if ever, justified in the absence of functional abnormality and disaster will likely follow
if operations are carried out in order that people might wear their preferred footwear. Foot shaped shoes
are the order of the day - not shoe shaped feet.

14 . 2 Flat Feet

The painful flat foot is a rare entity. Symptom tree flat feet are a normal variation and are very common in
certain races.

Rarely, a very painful spasmodic flat foot may be associated with infection or chronic inflammatory disease.
Occasionally it occurs acutely in middle age and examination reveals a painful and tender swelling over the
insertion of tibialis posterior. This may indicate acute or impending degenerative rupture and warrants early
intervention.

Mostly the condition is benign and if pain-free should be ignored. If associated with pain, a medial heel lift
will correct the deformity of the hind part of the foot and stabilize the medial arch. If pain is a persistent
problem, fusion of the subtalar joint will help, although this is not something to be undertaken lightly as it
disturbs foot and ankle function profoundly.

14 . 3 Bunions and Corns
Bunions are fluid filled bursae which are found around bony prominences, commonly over the distal part
of the first metatarsal and occasionally over the fifth. They form as a natural response to pressure and
indicate an underlying abnormality which should be treated rather than the bunion. Occasionally they
become infected and need drainage, followed a few weeks later by treatment of the cause or a review of
the footwear. Corns are another way in which the body reacts to areas of high pressure. The painful
excessive corny skin may be superficially removed but in the long term it will recur unless the underlying
cause of the high pressure is removed.

http://www.footphysics.co.uk/adult-pain-injury-conditions/foot-pain-causes-and-
treatments/bunions-hallux-valgus/