Fusing the bunion and hammertoes

Previously, I had bunion and floating toe surgery on my left foot. The problems came back although not quite as severe. I want to have surgery on my right foot to correct the bunion and two hammer toes. The doctor has told me they will need to be fused to avoid returning. My question is, will I be able to exercise with fused toes? I know they will not bend however can I jog? Will my gait be different? Should I get a second opinion? The doctor is saying that my foot problems are aggressive so if they are not fused then they will return.

RESPONSE

Hi,

Based on the title of your post, I assume your doctor wants to fuse your bunion AND fuse the second and third toes, so I will base my response on that assumption.

I wish you had included a picture of your foot or even pictures of your x-rays as they would have been very helpful.

Additionally, I would have liked to know how old you are particularly in regards to fusing your bunion. I do gather that you are very active.

In deciding to fuse the bunion joint more so than your hammertoes, a number of issues have to be looked at.

The first is your level of activity. The big toe has to be positioned in a proper position, then fused, so that you can "propel" off the toe as best you can when you ambulate. If not positioned properly, it will give you major issues particularly if you are a runner. (Having said that, I have read comments over the years from people and doctors who state that runners can do very well with a fused big toe joint).

At the very least it will change your gait pattern somewhat, whether or not that becomes an issue remains to be seen.

In my mind, a big toe joint fusion is a procedure reserved for those who are older and more sedentary, but there is certainly arguments against that line of thinking in the medical literature.

Sometimes the hardware used in maintaining the fusion can be an irritant as well, particularly in active individuals. As you can see there is not much fat around the big toe joint, so hardware will be palpable and may end up being irritated in your shoes.

As you may be gathering, I am not a big fan of bunion fusions as I think there are other procedures out there including implants and joint arthroplasty (Keller bunionectomy) that will afford the same relief but will allow the toe to bend somewhat.

As far as fusion of the hammertoes goes, you have to look at the architecture of toes in relationship to one another. If you stand up and try and flatten your toes as much as possible and your second toe and possibly third toe are much longer than the big toe and fourth toe, then fusing these toes may present an issue as well.

Since they will no longer have the capacity to bend, what generally happens in most people is the end of the toes hit the end of your shoe and create corns at the end of the toes, which for some people can be very painful. I would imagine the potential for this problem will be exacerbated in a runner.

If you are an older individual whose circulation may be on the decline, these corns may breakdown and become either infected or ulcerated which now becomes a problem much worse than the original hammertoes.

So, potentially you are looking at having three toes fused. Without the luxury of actually examining you to see how severe your problem is to begin with, I am having my doubts about the overall success of this line of thinking by your doctor.

So here is my suggestion. Absolutely, get a second opinion, perhaps even a third opinion as you are about to make a decision that will impact your ability to walk (and run) for the rest of your life. Try to see a foot specialist who understands the biomechanics of the foot (the way the foot functions) rather than just some one who is looking at a foot and x-ray and just trying to re-align everything.

If you decide to go ahead with the proposed procedure, ask your doctor what his success rate has been particularly with active runners.

The problem with this type of surgery is it cannot be undone, particularly with bunion fusions as I have always viewed them as a last option, not a first option.

Marc Mitnick DPM
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