Bone not healing well after 7 weeks post bunion surgery

Went for my 6 week post op visit, Dr told me to bring a flip flop to go home in but when i told him im getting sharp pains in my toe since pin was removed at 5 wks and feeling clicking he sent me for an xray. After he said that my foot looks much better on the outside than the inside and that it is not healed yet and to continue to wear the surgical shoe. I am now at almost 7 weeks and am still walking on the outside of my foot cause it hurts too much to put pressure on my toe. I see the dr again in a couple of days and was wondering if this was normal and why this is happeneing. I have been walking in the shoe since 2 weeks post op and my dr told me i can go back to work whenever i feel up to it. Im a hairdresser and on my feet up to 11 hrs a day. I went back p/t at 3 weeks post op. By the end of the day it would swell and hurt but i would put it up and put ice on it. But since he took the pin out the pain is getting worse and i couldnt go to work. Any input would be greatly appreciated

Brenda

RESPONSE

Hi Brenda,

Let me first give you my disclaimer and that is I am making the following comments without having seen your x-ray and not knowing what type of bunion procedure you had performed and trust me when I tell you there are a couple dozen procedures that can be performed for a bunion.

I am making the assumption that you had an osteotomy performed, meaning that either the first metatarsal bone or the base of the big toe bone was broken and then re-set in order to give better alignment.

If you did not have an osteotomy performed then your doctor would not see anything on x-ray that "was not healed" with the assumption being, he observed that the surgically broken bone has not healed.

The fact that you are still having so much pain and probably more importantly, the fact that you are feeling that "clicking" tells me there is a good chance that the bone has not fused nor has it come close to fusing and if you are already at six weeks, the chances of it ever fusing is diminished.

The clicking means that the piece of bone that was surgically broken is moving every time you take a step and that is what causes the clicking. The fact that it is moving will certainly dramatically diminish the possibility that the bone will ever fuse, because every time if moves which I assume is numerous times during the day, it breaks up whatever bone to bone bridging that might be trying to occur. That is why we usually put casts on broken bones so that they cannot move and are thus able to heal. This is not to say that all osteotomies regarding bunions have to be casted.

Apparently, while the K-wire (pin) was still in, the bone was being stabilized and you did not have much pain, once the pin was removed, the bone was no longer stable, it began to move and now you have pain and clicking.

This is a potential complication of this type of surgery, hopefully, you were made aware of this before consenting to surgery.

Going forward, your doctor has some options available to him and pretty much will be determined by how displaced the fracture is. Displaced means the amount of space between the ends of each broken bone.

At six weeks, if the osteotomy is well positioned when you are off weightbearing and only moves when you walk (click), then he might want to be more aggressive in his immobilization approach, meaning he might want to put you in a cast or even put you non-weightbearing on crutches, so that the bone stops clicking and stays in place.

If the alignment is good, he may also consider getting a bone stimulator for you which is a device that helps bone to heal. Depending on the type, it can be used for as little as 20 minutes a day, to a device that you wear in the area all day long. If the displacement is too great, then you may have to consider additional surgery to put the broken bone back in place and then have it fixated with something better than a pin, such as screws or even a small plate depending on the type of osteotomy performed.

The problem here is that at six weeks and going forward, you are increasingly susceptible to what is known as a non-union, where the "broken" bone either never heals on its own or heals poorly giving you continued pain.

I would also suggest to you that if you are a smoker or are old enough to be suffering from osteoporosis, both these issues can work against the broken bone from healing and you might want to discuss this with your doctor as well. Additionally, diabetes, anemia and if you are on steroids for some other condition, may also work against the healing process.

Marc Mitnick DPM
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