Over the years, my big toe had pushed the next two toes towards the little toe. I had a bunionectomy to correct the bunion, however the toes still point off to the side. My Dr. told me that they may correct over time, or he could do a tendon release. I said no to additional surgery, but wonder what are the odds of the toes straightening on their own. Is there something else I could be doing to help the toes move back to their normal position? Thanks.

There is nothing you can do, besides surgery, to straighten your toes. There are things you can do to keep them from getting worse. You may be in a shoe that is not long enough and not wide enough for your feet. I would suggest going to a comfort shoe store to have your feet measured and properly fitted for athletic or comfort shoe. You may also, want to consider orthotics which is a shoe insert. You can read more about bunions (big toe curving toward little toe) and hammer toes (smaller toes bending) at foot.com.

Sincerely,
Suzanne Belyea, DPM, C.Ped.

I too have a prominant bunion and toe pointing off towards the other toes. This is the into I have looked up about it and the ways to correct it.
Windy

Bunions
What is a bunion?
A BUNION is a "bump" or buildup of bone on the inner side of the large toe (medically called the GREAT TOE).


The bump forms as a result of a " bony callus " after many years of wear and pressure on the side of the great toe. Much the same way a skin callus forms on the palm or heel from pressure. The bony bump is not a tumor or malignant growth.


Medically, the bunion condition is referred to as HALLUX VALGUS because the great toe with time, angulates. The instep of the foot widens; the metatarsal bone of the great toe juts out along the inner border of the foot, and the tip of the toe angulates towards and, sometimes, under the second toe. Also arthritis of the joint of the great toe can occur.


Causes
Bunions are common. Many people have them. Women more frequently than men. Improper shoes are undoubtedly a factor. Typical woman's pumps - high heels with narrow and pointed toe boxes certainly have been implicated as a major cause. I believe that such shoes can be one of the causes - or at least - aggrevate a foot that is predisposed to develop a bunion.


However, there are other reasons why hallux valgus occurs:
-Genetic - familial factors - especially in teenagers.
-Loose ligaments
-Anatomic varients
-Flat feet - anyone with a flat, pronated footwill note increased pressure placed on the inner border of the foot


Non-operative treatment
In adults, the choice is usually between surgery and conservative shoe corrections. Of course, this depends on the severity of the problem. A mild bunion which causes little trouble should be managed with better shoes: flats, good arch supports, wider toe box. If one has a flat or pronated foot, an arch support, orthotic, or insert such as a scaphoid pad will better position the foot, thus relieving the pressure on the great toe.


Medicine,thearpy, braces, straps,exercises, etc. will not help.


Also,surgery is probably not suitable for an elderly patient ( over 65 - 70 ) with possibly poor foot circulation,or diabetes. Foot surgery in this age group may be risky and therefore it may be wiser to consider shoe corrections or custom made shoes.

Surgery
Surgery is intended for someone with considerable trouble - pain with moderate activity, standing, or walking. Or difficulty wearing most shoes. Someone who has tried shoe changes or corrections with poor success. Surgery would also be indicated for a person with a severe foot deformity or for an adolescent who will predictably develop a severe hallux valgus deformity later in life.


Over 130 operations for bunions have been described , so I will limit this discussion to four types of surgery


Simple Bunionectomy
Removal of the bump). This is somewhat minor surgery and the results are good. It would only be indicated in someone with a fairly straight toe a mild hallux valgus, and of course, a painful bunion.


Keller Procedure
This is a common operation - performed mainly in older people. Part of the great toe joint is removed. The ligaments are tightened. It is not an ideal procedure: the toe is shortened and may become floppy. (somewhat cosmetically unsightly ). Pressure may shift toward the other toes. The deformity may recur.


Still, it is a simple and usually successful operation, allowing for a quicker and more predictable recovery. This is a plus for an older person or a patient with Rheumatoid Arthritis.


Osteotomy
The bones of the great toe are surgically cut and re-directed in a straighter position. The altered bone is held with a pin , screw, or cast until the break heals ( usually 6 - 8 weeks ).


Advantage? This operation re-structures the foot and it is the best way to correct the deformity. A disadvantage is that the bone has to heal and the foot requires protection with a cast and / or crutches until the bone mends. Thus, the recuperation is longer, and if the bone doesn't heal or displaces, additional surgery may be necessary.


This is usually not a problem in a younger person and for a teenager with a bunion, it is probably the procedure of choice. However, in an elderly patient, the risk if non-union (failure of the bone to heal) is greater - not to mention the lengthly recovery. Again, the Keller procedure may be advantageous.


Soft Tissue Procedures
These operations tighten ligaments and transfer muscles to correct the deformity. Instead of a muscle pulling the great toe out , it is transferred to pull it towards the other direction. Soft tissue operations are frequently performed with other operations such as the Keller or ostoetomy. One potential disadvantage is the risk of "over-correcting" the deformity - resulting in an unsightly toe.


Other operations such as fusions to stiffen the toe and silastic implants are rarely done. Also, surgery is done to correct a deformity or to relieve pain - not for cosmetic reasons.