Brachy Toe FUNCTIONALITY

I'd like to talk about the actual function and alignment of my fourth toe with this corrective surgery. I think it's important and seems like no one is talking about it. As I stated in my very early posts, I wasn't just interested in an esthetically pleasant looking toe. I wanted to know about functionality, but no doctor really had abundant specifics on that. They are just sure not to promise anything. And if you don't ask about certain topics, they won't bring it up either.

So let's get to it. My take on it at this point is that Dr. West went a little overboard with "over-correcting" my toe. My best guess is that from his medical perspective of how the foot functions, toes are your grippers and offer a great deal of balance for the body. If he had to choose between a floating toe or a toe that grips the floor too much, he would choose the later. BUT, that's giving him the benefit of the doubt.

There is no doubt that I've done my exercises, etc. I even took Dr. West's advice about wearing heels after surgery to help gain range-of-motion (mostly for the Bunionectomy he did.) (See that post here. Once there, scroll down to the bottom  and read the short blurb starting at: "Other things...")

Bottom is BEFORE wearing the heels,
Top is AFTER wearing the heels.
(I'm reclined forward in both shots.)

This image shows my fourth toe after wearing that heel for about 3 hours. In the top image, my fourth toe isn't pressing against the floor more than the other toes as in the bottom shot. But then my 4th toe settles back down and is like in the before image, which is set too low. imo.

You can see here, when I lean my body forward, the fourth toe shows a great deal more pressure onto the floor than the other toes. (See the yellow tip of the toe?)

This photo shows you how it is set too low. As you know, it was even lower 10 weeks ago. The exercises have placed it up this high. But now at my 20th week, it seems this is as good as it will get? Thus, Dr. West went too crazy with the over-correction. (Remember, this is my opinion.)

The imprint of my foot on my flip-flop demonstrates what I'm talking about. My fourth toe is pressing against the floor much more than my other toes.

So why does this matter?

I'm glad you asked.;o)

It causes several difficulties. 

1. I'm not so sure it is healthy for the bones in that toe to be under this constant 'resistance' pressure.

2. Being set so low forces the entire 4th toe to touch the floor. That's not normal.

The stem of your toes do not usually touch the floor consistently. There isn't enough meat (cushion) in that area like the tip of your toes. The tips of your toes were designed to touch the floor consistently, not the stems. If they were, you'd have more meat there to deal with the pressure of your bones against the floor.

So that is what is happening to me. The stem of my fourth toe is being forced against the floor by the way the bones are set. This causes discomfort. I can't walk barefoot without discomfort so I have to keep foam flip flops near by.


Before my surgery the 3 bones to my fourth toe were in a curved high position (see "B" below). Also, the 4th metatarsal bone that was elongated, seemed to have a portion of the bone, that by nature, protruded downward. (See "A" below. Orange.)

This is verified in "C" below when you look at the shape of those bones. (Orange) 

And now all of that has been set downward. Too downward. Look at the bones for the 1st and 2nd toes in "C" (black and pink). The bones for the 4th are way too close to the floor now inside my foot. Perhaps this is the only way to get a Brachy toe to stop levitating?

*Double-click for larger view.*

3. Another thing it causes is the stem of the 4th toe to press against the skin of my foot, trapping moisture.

I learned in my 20s, when I had my Brachy toe, that I had to be sure to keep the skin under that toe very dry. Otherwise I'd get athletes foot in that one little area beneath the toe. The moisture would sort of eat away at the skin and cause a wound. 


Well I guess I'll have to watch out for that now too with the stem of that toe trapping moisture because of the way it's pinching the skin. ;o/

"Trade-off" is a topic more of us need to address with this surgery. You gain some things you wanted, but you also have chances of gaining some things you don't want too.

I'm seeing Dr. West in a week for my right foot. I need to gather myself and see what is worth mentioning to him and what is not. I think he is a good doctor. But this condition, being addressed by doctors, is a new thing. 

My job is linked to the medical community. I know all too well the mind-set of doctors. It's a whole different world. Even good doctors practice keeping silent about things they feel are 'touchy' areas.

There is something I do want to mention to him and need to find a constructive way to do it. The Bunionectomy he did for my bunionette is disappointing. He missed the mark completely to what I had complained about in my consultation with him. The bone I needed him to shave down, due to pain in shoes, wasn't touched. Instead he worked on the "profile" of the bunionette. He did what he called a sort of "tuck" with the skin. Which looks real nice. ;-) It makes my foot look narrower. I really like that— I want him to do that to my right foot. BUT I think it's unacceptable to go through all this and still have the bone I initially complained about still be a pain issue. (turns out he did miss the mark and unless I go under the knife again, I'll have to live with it.)


I do have a small suspicion that perhaps it was not done because it can't be done. You know, like it's part of the joint kinda. But I have to talk to him about this cuz there needs to be understanding between us before doing my right foot.

I think it's important to extend grace to people who are trying to help you. I don't want him to think I don't trust him, cuz I do. I wouldn't travel so far if I didn't.

I have no idea if Dr. West will volunteer to fix what he missed last time on my left foot. It would have to be very un-invasive  because I need my left foot to bare all the weight while my right foot is healing.

Anyway, I'll see how it goes. It's important to be gracious and demonstrate understanding. He may not volunteer to fix what he missed. I need to be prepared for that.

On a good note, in a week all my surgeries will be over. Thank God. ;o)

Tootles.