My left big toe will not lie flat.

by Ken
(LaGrange, GA, USA)

My left big toe will not lie flat. Sometimes it almost stands straight up. Just had them xrayed. Doctor said surgery is not an option as it is calcified. My balance is being impacted. What options do I have?

RESPONSE

Hi Ken,

It sounds like your toe is going into some kind of spasm as you mention that at times it almost stands straight up. I mention this because most people who have a big toe that will not lie flat generally exhibit a toe that is slightly elevated off the ground. This is actually quite common after bunion surgery.
So I need to know if the toe is actually going into some kind of spasm or because of some kind of calcification the toe gets locked in an upward position.
I am at a real disadvantage here because I cannot examine you or even look at an x-ray, but I will say this.
If there is a bone block (calcification) that is causing the toe to become locked in an upward position, I do not see why the calcification cannot be removed. (I also wish I knew how old you are).
By removing the bone block, in theory at least the toe would not lock in an upright position.
If your big toe is actually going into a spasm that forces it straight up, assuming no neurological issues, you could have work done on the tendons that bring the toe upwards. By lengthening them, this would reduce the spasm that is occurring.
If when your toe is straight up I could see how it might be difficult to walk and maintain balance, but if you are referring to just a mild elevation of the toe makes it difficult to walk then there is another option available to you.
That would be through the use of an orthotic, which is a device that fits into your shoes.
This could not be a store bought arch support but rather a custom made device that would essentially have a filler added to the forefoot in the big toe area.
Essentially what you would be doing is bringing the ground up to the toe so that the toe does not have to purchase the ground.
I think that modification would give you better balance when you walk.
I think it is important in better understanding this problem to know how long it has been going on.
If it is something you have had for many years but now it is causing gait issues, then an orthotic as I just described might be very helpful.
If this is a recent event then you need to find the cause of this problem. (again, knowing your age might have been helpful to me)
If you are middle age or older than I would understand the possibility of a bone block and as I said earlier, surgery to remove the block might be very helpful.
If the toe is going into some kind of spasm you need to find out why that is happening. Usually it has a neurological component to it.
Lastly, if all else fails AND your are really miserable, there is always a fusion of the big toe joint. Your toe would then purchase the ground but your toe joint would not move at all. For some this is a great procedure, however, I am not a big fan of this procedure, simply because you toe is now locked in a permanent position and this too can create walking issues.
So first you must identify the underlying cause of the problem, it then becomes a lot easier to rectify the problem.

Marc Mitnick DPM
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