The big toe on my right foot sticks out to the left. My second and third toes are hammertoes.

by Marcie
(Ludington, MI USA)

The big toe on my right foot sticks outward, and the second and third toes are hammertoes. I'm scheduled to have surgery at the end of March, 2016. The doctor recommends fusing the big toe, and fusing the middle joints in the hammer toes and releasing the tendons on the hammertoes. He'd put a plantar plate under the 2nd and 3rd toes. The other option is to do a tightrope procedure on the big toe.He's unsure how well the tightrope cable will last. I'm reluctant to fuse the big toe, because I'll have no flexibility in the big toe joint. I'm 53 and active.I also have back pain, and I'm afraid the change in my gait will make the back pain worse. I'm having a very hard time with shoes fitting comfortably. Ones I've worn for a while now hurt my feet. I buy wide width, but sometimes that's not enough.

What can be expected after fusing the big toe? What do you know about the tightrope procedure? I have a CD of the x-ray, but I don't know how to attach it. Sorry.

RESPONSE

Hi Marcie,

Not really clear on what is going on, based on your narrative. Usually in a bunion deformity the big toe points toward the second toe, not away from it and it is the first metatarsal bone that is pointing away from the other metatarsal bones.

What you are describing sounds more like a failed bunion procedure where there is an over correction and now the toe instead of being straight, is pointing away from the second toe. If this were the case, your surgeon would not be talking about the tightrope procedure, although he or she would be discussing a fusion.

I have repeatedly stated on this site that I am not a big fan of big toe joint fusions in most cases. The only time I think they are necessary is in failed bunion surgeries where there are no other options.

Assuming you have never had bunion surgery before, and you are active, even without having the luxury of examining your foot, I would think you have other options. If the surgeon is even discussing a tightrope procedure that tells me the joint is salvageable and so there are other procedures available.

There are many references in the literature about the cable breaking after the tightrope procedure. If you have thin metatarsal bones and any real degree of osteoporosis, I would stay away from the procedure.

I won't even go into why I don't like bunion fusions simply because as I stated earlier, if the surgeon is considering a tightrope procedure then that tells me you are a candidate for other bunion procedures as well.

You mention the surgeon is going to put in a plantar plate under the second and third toes. I don't even know what that means. You may have what is known as a plantar plate tear and he is going to repair it, but as far as I know there is no such thing as as a plantar plate.

My best advice to you is to get a second opinion from another local surgeon before you go ahead with your surgery, simply because I do not think things have been properly explained to you, and secondly because a choice between a bunion fusion and tightrope procedure does not make any sense to me.

Marc Mitnick DPM
DISCLAIMER