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The response to the question below was authored by Marc Mitnick DPM

Foot is deformed 1 year after surgery

by Anna
(St. John's MI USA)

I had bunion and hammertoe surgery about a year ago on my left foot. Instead of removing the bunion the doctor just shaved it. As a result when it healed, my big toe healed severely bent to the left. It pushed the toe next to it out of joint and now it is crossed over the middle toe and won't straighten out. I have to wear a foam piece to keep my toes from rubbing together. I used to be able to wear "B" width shoes but now my left foot is one and one quarter inches wider than my right foot. The bunion is bigger than it was before the surgery. Even extra wide shoes don't fit on my left foot without hurting. I went to my doctor and he said live with it my foot will always be wider. I have a lot of skin breakdown on the second toe because since it crosses over the middle toe, it rubs against all my shoes. My foot was relatively normal before the surgery but now it looks deformed, kind of like a clenched fist.

Would a surgeon be able to straighten out my toes and rework the bunion? It hurts all the time so I am mainly concerned for pain relief and being able to wear normal shoes again.. I included a picture of both feet for comparison.

RESPONSE

Hi Anna,

Unfortunately, there are no pictures included with your post. Speaking in general terms, your foot may require additional surgery. Yes, having included pictures might have been helpful to offer a more specific opinion, but I will try and answer your question, regardless.

When we as foot surgeons evaluate bunions we do so both from a structural standpoint such as reviewing x-rays and actually measuring the angles formed between the first and second metatarsal bone as well as the angle formed between the first metatarsal bone and the big toe.

We also look at the quality of the big toe joint as it appears on x-ray, however in most cases the quality of the joint is
usually worse on actual inspection during surgery.

We also evaluate bunions on the needs of the patient. What I mean by that is just because an x-ray may suggest one type of procedure be performed, the needs of the patient may suggest that the patient can get by with a different procedure, usually a procedure that requires less work and therefore quicker recovery time.

Sometimes a lesser procedure has to be performed simply because the patient is not a good candidate for a more involved procedure. I do not know how old you are, but older individuals who may exhibit osteoporosis which results in poor bone stock, or if the patient is a chronic smoker, a surgeon will be less inclined to do a more involved procedure simply because it may not heal.

I should say, in the case where a lesser procedure is done, such as just having the metatarsal bone shaved, the result should certainly be some degree of improvement, not a worsening of the condition.

I have no way of knowing why your big toe moved further away after your surgery. The most obvious reason, but the not the only one, would be that the surgeon did a poor job of closing the joint, after the "bump" was removed.

Making the assumption, that you are reasonably young and in good health, you could consider additional surgery to re-straighten the big toe joint, as well as possible surgery on the second or even third toe to better align the toes. More than likely this will be a much more involved procedure and will require more sacrifice on your part.

If it is pain that is motivating you, then by all means seek an opinion from another surgeon and perhaps even a third surgeon on what the best course of action would be. The problem with "re-do's" is that they present special problems that have to be taken into account, so having more than one opinion could be very helpful in order for you to decide if further surgery is right for you.

Marc Mitnick DPM
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Jun 21, 2015
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by: Anna

Thank for your help. I did attach pictures but they must not have gone through.

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Columbia University Department of Rehabilitation

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Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

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American Family Physician

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