Spreading middle toes

by Valerie
(Sebastopol, CA)

In Feb. 2011, I had extensive surgery on my left foot for bunion, bunionette, hammer toe. I thought I was healing okay because I had the exact same surgery done on the other foot with no problems. In April, I experienced some pain under the ball of my foot and the doctor said it was probably scar tissue and to ice massage it for 10-15 min. a day, twice a day. I did that and it kept it comfortable but it still hurt if I walked on it too much.

In July, I noticed that my two middle toes were beginning to spread. They got worse so I went back to the doctor, not the surgeon who operated, but one of his colleagues.
He told me that my big toe joint is shorter than the rest of the toes so that when I walk, the pressure is on the ball of the foot instead of the big toe. I vaguely remember the surgeon saying that he done something to the ligament.
The doctor said I should take an anti inflammatory for a week and wear a surgical shoe with an insert until the pain goes away. He also wants me to get orthotics. He said as a last resort, another surgery was an option.
Does his explanation sound logical and correct?
Thank you for your opinion.

ANSWER

Hi Valerie,

When the first metatarsal bone is shorter than the second (or the second is just excessively long) it tends to put excessive pressure under the second metatarsal head when you ambulate. When evaluating bunions and possible surgery, this factor needs to be taken into account as you want to avoid doing procedures that further shorten the first metatarsal bone.
You do not mention what type of bunion procedure who had, but if you had pins, or screws or a plate put into your first metatarsal bone, then chances are you had a procedure that shortened the first metatarsal.
This obviously would then put more pressure on the second metatarsal head which could result in pain and swelling. If there was enough swelling it theoretically could cause splaying (spreading) of the the second and third toes. You do not mention which toe(s) underwent hammertoe surgery and depending on the type of procedure, that too could explain the spreading of the toes.
Since this all happened as a result of the surgery you would have to assume there is some kind of "cause and effect", but I will tell you that most cases of spreading of toes that I see are due to some kind of growth in between the metatarsal heads where they attach to the toes. Usually the growth is on the bottom of the foot, but when the patient stands it moves in between the bones and causes the toes to spread.
If your doctor is comfortable with the idea that your problem is due to the actual surgery (since he has more information available to him than I do) then leave well enough alone and go with the orthotics. In theory if you wear the right kind of orthotic and the swelling and pain goes away then your toes should no longer spread.
If that turns out not to be the case then perhaps an MRI of the foot to rule out soft tissue pathology in between the toes/metatarsal heads would be indicated.

Marc Mitnick DPM
DISCLAIMER: