Big Toe Sticks Up/Loss of Balance

by Sherry
(Virginia)

I had bunion 2 years ago on both big toes and now neither toe touches the ground & I'm having balancing problems. My left big toe sticks up higher than the right one. The toe next to this one is taking most of my weight to balance & I now have a bone sticking out from the lower inside and both of my legs always ache from just above the knees to my ankles due to the strain of my weight shifting to balance myself (my knees do not hurt). Neither foot is painful, however I'm concerned about the left second toe is almost flat & the bone sticking out and the constant aching in my legs. Is there anything that can be done?

RESPONSE

Hi Sherry,
A dorsiflexed toe, or a toe that is bent upwards is a somewhat common complication of bunion surgery. It can come from a number of reasons but in most cases it is due to the way the first metatarsal bone is cut. If an osteotomy (cutting of bone) is performed on the first metatarsal and the head of the bone is set too far downward, it will force the big toe up in the air.
Less common causes are from over-tightening the soft tissue around the toe joint and sometimes from excessive scarring.
In most cases this is a cosmetic issue more so than anything else with a secondary complaint by the patient of having problems buying shoes because the big toe now rubs up against the shoe.
Although I have never personally experienced it, I suppose loss of balance could be a factor particularly if the toe is excessively bent upwards.
If the position of the big toes is forcing you to walk abnormally in an effort to balance yourself, then the argument could be made that your leg(s) could hurt from the overuse of certain leg muscles in an effort to ambulate without falling.
Since you state your bunion surgery was two years ago, it is safe to say that the position of the toes are now fixed in this position and there is no simple way to correct it.
The obvious suggestion would be more surgery. First your surgeon must find the cause, and as stated earlier in most cases it is from the head of the metatarsal bone being plantarflexed (bending downward). Unfortunately, to correct this, the bone would have to be broken again and then reset. Of course that would require a sacrifice on your part once again, going through the whole healing process.
If your surgeon determines the metatarsal bone is not the issue, then soft tissue repair might bring the toes downward. This sometimes takes some creative thinking on the part of the surgeon as it might require lengthening ligaments and re-routing tendons in an effort to force the toe back down.
I think the assumption could be had, that if the toes were once again properly aligned and you had your sense of balance then your leg pains would cease.
If you decide to go this route, I would suggest you get more than one opinion as this is not a totally straight forward procedure.

Marc Mitnick DPM
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