Hallux Varus: Splinting Possibility

Dear Dr. Blake,

I came across an article from Podiatry today regarding non surgical solutions for patients who had a failed hallux valgus surgery in the past, this is my situation - I am a 55 year old woman - that is active and busy at work.  I live in NYC, otherwise I would make an appointment to see you. I am suffering from this condition  after my bunions surgery went wrong. I am really looking for some kind of orthotics to help me with basic things as walking - since my big toe is always going to the outside - is there something else than taping it together that you can recommend?

Please I really appreciate your help and will be really thankful with any ideas/tips about it.

Thank you!

Dr. Blake's comment: For walking, get 1/4 inch adhesive felt from Alimed and place it along the medial side of the big toe to gently push towards the 2nd toe. 
https://www.alimed.com/felt-plain-and-adhesive.html?pid=71891

A local brace shop should be able to use multiform, also from Alimed, to fashion a sleeping brace. Depending on how tight your tissues are, they can slowly move the first and 2nd toes closer. A sheet is cut out about 8 inches long and 4 inches wide. My little video here shows the way they would wrap the multiform. A sock will have to be worn with it.

 https://www.icloud.com/attachment/?u=https%3A%2F%2Fcvws.icloud-content.com%2FB%2FAX3GxRhBCmvKSgCBRR1T7W_rsp1qAdqnLIxCG0JiCYJLgVKAGB0_xTEZ%2F%24%7Bf%7D%3Fo%3DAhMws-pMZr_EyWlMldfUmGpiP1tCSq5lpm9mpzGPoMEH%26v%3D1%26x%3D3%26a%3DCAogy7KaaxWHJf4HlITvLmVne3lDGqP0jWe3O2P_bPFWfM4SJxD1s4CSgi4Y9cP75YsuIgEAKggByAD_fxxETlIE67KdaloEP8UxGQ%26e%3D1583714591%26k%3D%24%7Buk%7D%26fl%3D%26r%3D5FED7B9F-275F-4FC7-8E44-E3EA89D039D5-1%26ckc%3Dcom.apple.largeattachment%26ckz%3D92E7AC4E-8C1A-4612-9089-7BA3BF80F571%26p%3D43%26s%3DHzXROJt9T5Ze2NxP_lS6Fs1CR5Y&uk=IlC2Hp8yayJaQE0LrcdshQ&f=IMG_6599.MOV&sz=68183935

https://www.alimed.com/alimed-multiform.html?refSrc=921124&nosto=productpage-nosto-1

You also need to strengthen the right muscles. So, metatarsal doming must be done with the toes taped together along with single leg balancing. Hope this helps. Rich
PS you can always go to PT and have them make sure you are do the right exercises, but also increase the mobility of the lateral and medial capsules of the joint to allow it to be pulled back. 

Hallux Varus after Sesamoid Removal Years Later

Hello Dr. Blake,

I have just spoken with your nurse/receptionist and she suggested I describe my foot concern to you.
I had sesamoid surgery on both my feet twenty-five years ago in Pasadena California.
Up until last summer, my feet were handling my everyday wear and exercise just fine.  
But, in the summer, I decided to wear a flat sandal with no side support.  In one month my large toe on my left foot began moving off my sandal!!!  At night I experienced shooting nerve pain from my ankle up to my knee, consistently for weeks.  I saw my podiatrist and he put me in a boot.  Had no other suggestions.  I then saw three prominent foot surgeons.  They all suggested “orthotics.”  
One of the surgeons gave me a shot of prednisone in the big toe of my bad foot.  
This did help with my nerve pain and foot discomfort.  

In caring for my foot I bought wide enough shoes to fully support the expanded width of my left foot and my disfigurement. 
I am athletic and always have been.  Since my foot alteration, I am walking with orthotics.   
One week ago, I was trying to make an appointment and was required to walk for at least 35 minutes in a sandal which has good support for both my arch and bunion area. Well, I thought.  I am normally paranoid to wear only a few pairs of shoes that work with my condition.   
The result was concerning.  My foot feels that it has become disfigured even more.  

I have been compensating for the past year, to not put full weight on my left foot.  Currently, I am having knee pain in my right knee.  I transfer my weight constantly.   I have taken a bad fall heading up the stairs because of my foot alteration. Every step I take is now is a concern to me.  

My question is are you a surgeon and do you know how to repair a condition like mine?  If not, do you know a surgeon who can which you recommend? 
I appreciate your time and consideration. 

Dr. Blake's comment:

     Thanks for the email. It sounds like Hallux Varus where the big toe moves away from the 2nd toe. If that is the case, surgical correction is necessary to realign the joint. Care has to be taken not to make the joint too tight, causing a limitus condition, and thus causing more of a problem. Send me a photo of your foot for this post to make sure we are talking about the same thing. Also tell me what sesamoid was removed many years ago. It makes sense that the fibular or lateral sesamoid was removed making it easier for this to occur. 
     Since you are 400 miles from me, and our surgeon (I only perform rehab), here is a list. My go-to guy in that area has always been Dr. Altchuler (Santa Monica) 310-451-8045. But, I have confidence in Franklin Kase (Burbank) 818-848-5583, Brian Hong (Oxnard) 805-988-3338, a member of my class Leslie Levy (Valencia) 661-254-0795 and Jan Tepper (Upland) 909-920-0884. Use my name as the referring podiatrist. After they exam you, you want to get two surgical opinions. They may be one, and then get the name of the doc they would have it done if them. Keep me in the loop. Rich

Further comment: Thank you so sending me the above photos. It almost looks like a breakdown higher up your arch, then typical Hallux Varus. This will take a good workup. Please get some 1/4 inch adhesive felt from www.mooremedical.com and apply to the medial side of the big toe when you are wearing shoes to push it over towards the second. Also, get an OTC arch support from Sole or Powerstep and begin to wear that it comfortable. Keep me informed. Rich

Bunion Surgery Complication: Hallux Varus

Dr. Blake, 

I had a bunionectomy 12 years ago when I was 18 and now have a rather prominent hallux varus on my RT big toe.
Dr Blake's comment: Hallux Varus is where the big toe points towards the other foot and away from the 2nd toe, and definitely a significant complication and shoe fit nightmare.

 I honestly didn't know that this was what my condition was called until recently and thought for years that the space was normal aftermath of some bunion surgeries. I am concerned now because I have recently noticed some friction while walking in between my 3rd and 4th toes and I am unsure if this is related or not.
Dr Blake's comment: Probably only related because the destabilization of the big toe joint is leading to changes in the rest of the foot. 

 Also, knowing that my condition is not necessarily a normal expectation from my surgery, I would also like to find out if I can do anything non-surgical to correct the problem given the time lapse since surgery. If you can provide me any suggestions or insight into what might benefit me, I would greatly appreciate it. 
Dr Blake's comment: Where you can not tape the first and second toes together (may function differently), you can try to develop the adductor hallucis muscle which pulls the big toe towards the second. Please review the metatarsal doming video, and send me a short 30 sec vid of you attempting this seen from in front of you. I can then instruct you on how to modify to get the adductor hallucis. 



Just to let you know a little about me. I am a healthy mom of 2 and not looking to or able to have surgery due to my children's ages at this time, but if that is a path that I may need to travel down in the future could you tell me what those indications might be as well. Thank you again.
Dr Blake's comment: I can not imagine someone attempting shoe buying with this, so perhaps yours is very very mild. Please send a weight bearing picture of both feet to see the difference. Rich

Regards,
Amy (name changed due witness protection)