2nd toe pain

by A
(NY)

I had bilateral bunion and hammertoe surgeries after which I have pain between 1st and second toes in both feet. I had a big toe fusion and capsulotomy on the right foot that did not reduce my pain. The MRI showed that I have 2nd interspace neuromas in both feet. However, the pain is not related to weight bearing. It hurts when I move my feet even in bed, and stops only when I stop moving.

The doctor thinks that my pain is not from neuroma. He wants to remove the plate and the screws to give me relief. I tell him that I had the same pain before the fusion and I have similar pain in my left foot, so how can it be related to the plate?

Despite the fact that the doctor does not connect my pain to my neuroma, he offers to remove the plate and my neuroma. I had very hard recovery after fusion, so it will be many months of recovery, and if it won't help, why to go through post operative pain again?
I am in the process of recovery already for 2 years. I ask for advice. Can pain between big toe and the second toe that happens all the time be the sign of 2nd interspace neuroma? I do not have a feeling of walking on a marble or shells, just the pain and very often cramps in the same area.

Thank you.

RESPONSE

Hi,

Before I get started with my assessment, I must insist you seek a second opinion from a foot specialist in your area. You are obviously faced with the prospects of additional surgery. Since, according to you, the first surgery did nothing for you in relieving your symptoms and it was associated with a long recovery, before you delve into more surgery, you need the opinion of another doctor who can actually examine you, review your films (MRI, x-rays) and give you options to consider.
I am a little confused in your narrative. You state you have pain between your first and second toes, but the MRI shows a neuroma in the second interspace. The second interspace (intermetatarsal space) is the space between the second and third metatarsals, not the first and second. So, now I am unclear where you actually have your neuroma. Even with that problem, I think I can be of some help.
If your neuroma is deemed to be the source of some or even all of your pain, then it has to be dealt with. That does not mean surgery, at least initially. I have had a lot of success with 4% denatured alcohol injections and in the seven or eight years that I have been using this type of injection, I have only had to surgically remove a hand full of neuromas that did not respond to the injections.
You mention that your foot hurts when you move it in bed, you stop moving it, it stops hurting. You also state that this occurred before the surgery as well.
So, in theory I agree with you that how can the plate and screws be the problem if the pain was occurring before the surgery?
On the other hand, many times hardware implanted into small areas can themselves become irritants over time and in many instances need to be removed.
Removing hardware and having a neuroma removed will probably end up being less of an assault on your foot then the original surgery.
All things being equal, I would think the best way to approach the problem would certainly be to get a second opinion particularly because it does not sound like your present surgeon met your expectations with the first round of surgery and according to you, does not sound like he is even listening to you. That would not be a big confidence booster for me. (keep in mind, I am only getting your side of the story. There may be other elements present that I am unaware of).
I would then consider having the neuroma treated non-surgically to see if your pain could be eliminated that way. (you do not mention whether you have had any neuroma treatment in the past).
If conservative neuroma treatment fails to relieve your pain, then surgical intervention would be your last resort. At that point which surgeon you use should be the one that instills enough confidence in you.

Marc Mitnick DPM
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