excessive dorsal flexion in foot due to surgery

by guy
(flint)

misdiagagnosed with sprain when really have achilles rupture.went ten months before surgery,tendon retracted up leg 7 inches ,Doctor had to take tendon from big toe to replace tendon in back of foot. It has been a year since surgery,now have to much dorsal flexion in foot,therapy says my foot should not be like that,it bends all the way upward also have a bad limp.Did the Doctor mess up during surgery? and is the tendon to long in my achilles?

Hi Guy,
Certainly, if a foot has too much dorsiflexion, it is going to cause an abnormal gait (limp), because the foot cannot properly plant itself in order for the body to move forward.
I think your best best would be either to see your original surgeon or perhaps get a second opinion from another surgeon as this problem should be fixable.
Marc Mitnick DPM

Arthrodesis - your advice.

by Steve
(UK)

Hi Mark

Thanks for a most interesting website, which has helped a lot.
I was hit by a car about two years ago, in the area of the dorsal side of my leg, although the main impact site turned out to be the foot.
As a result, the plantar and the medial inner side of the foot was left with a long-standing chronic inflammation and a stabbing pain on the medial side. Only recently, it has been discovered by MRI, that I had a small piece of bone broken and displaced at the metatarsal I bone near the joint. As a solution, I have been offered an arthrodesis of the joint, using a graft (to be taken from my hip). Could you please give me an insight to the implications of such an operation, regarding potential arthritic changes to any neighbouring joints of the foot, as well as others in the leg. Also, any possible non-union, as this is going to be a non-functional joint? Is there any alternative to this operation?
Finally, could this piece of displaced bone be the reason for the long-standing inflammation of the plantar and medial side?
Your advice would be much appreciated

Regards

Steve - UK

Hi Steve,
I am not sure if the broken bone you speak of is between the first metatarsal bone and the big toe bone (hallux) or between the first metatarsal bone and the bone behind it (cuboid bone). I mention this because if the fracture is between the first metatarsal bone and cuboid, having a fusion at this level has minimal negative implications.
An arthrodesis of the first metatarsal bone and hallux has more implications, however, a fusion of this joint is a fairly common procedure, many times done after a failed bunion operation.
In any event when a joint is fused it tends to put more pressure on the adjacent joints as it changes your gait.
I am only guessing here but if the fracture did not show up on xray but only on mri, to me that tells me it is not a very large displaced fracture and on the surface at least it would seem that it could be repaired by internal fixation, such as a screw.
Because your diagnosis does not seem to fit your history, I would think a second opinion might be indicated.
The fact that it has been two years since your accident your options are limited and there will probably have to be some surgical intervention but as I just stated it might not require a fusion.
Marc Mitnick DPM

bruising after bunion surgery

by Renee
(Kansas)

I had a bunionectomy with osteotomy about 4 weeks ago. There is still a lot of dark brusing around the incision site. Is this normal or should the buising be going away. It is pretty dark and not green or yellow. I had a screw placed in the 5th metatarsal.

Hi Renee,
Under normal circumstances the bruising should subside slowly over time. As long as you see it diminishing, even slowly, you are probably alright. If you are really concerned, ask your surgeon.
Marc Mitnick DPM

mal-union ,pain under foot were fusion was done, and burning.

by Ted
(TX)

Hello,

I'm a 31 year old male.I had a bunion surjury 23 weeks ago. it was a lapadas procedure. I was smoking about 5 cigs a day since the operation. I quit on week 2.

The fusion joint
is only 25% healed at 16 weeks per radiologist . I recieved a seconed opinion and that Dr. said that most likely there will have to be a second surjery to correct mal-union, which at this point he stated will most likly not heal and turn into a non union.

I'm a kidney transplant recipiant, 9 years since transplant and currently taking antir-
ejection meds as well as prednison. Both types of meds "have
been said by dr. that gave second opinion" could be the reson
for mal-union/non-union. The surjery Dr. aslo provided me with a
bone stim which I have using regurly avg 7 1/2 hrs daily since week 16 post operation. It has been 23 weeks since sujury and latest cat scan shows that the fusion site is less then 25% healed/fused which means a decrease vs an increase. The Dr. that preformed the operation said that the radiologist must have read it wrong because it looked like it was 50% fused.

Does this sound like it could be a long and painfull recovery and what would the worstcase/bestcase senerio be?

Thank You very much.

Hi Ted,
Based on your medical history and the fact that you are a smoker, I do not know if this surgery was in your best interest in the first place. I would stick with the bone simulator for another couple of months and have progressive x-rays to see if there is further healing. I have seen some amazing results with bone stimulators, however, if ultimately that does not work, then you will be faced with another surgery. If you are eventually faced with a second surgery, I would recommend you find another surgeon.
Marc Mitnick DPM

Bump from the screw protruding on my foot after bubionectomy

by Liliana
(Downey,Ca)

I had a bunionectomy about 6 weeks ago . I had a screw fixation and I notice a bump an my foot where the screw is . I asked the Doctor and he said it will get better once I start walking. I want to make clear this is not an absorbable screw.I will appreciate very much your opinion.

Hi Liliana,
I cannot imagine a situation where a protruding screw will get better over time. Screws, when properly placed should not move. So how this is going to get better is beyond me.
Sometimes after the broken bone is healed, screws that annoy patients have to be removed. It happens fairly frequently and generally is not a big deal to remove.
If you have real concerns, get a second opinion in your area.
Marc Mitnick DPM

Pain post-bunionectomy, hammertoe surgery

by Judy
(Indianapolis)

I had bunionectomy, hammertoe correction 6 days ago. I have been using a walker and hopping around. I have 3 pins in my foot which should be removed in 3-4 weeks. Today, the podiatrist gave me a walking boot and it really hurts when I try to walk. I think it is because of the pins, but then I have not been walking for 6 days. The podiatrist said to just walk a little bit at a time and then increase. Of course I can continue the pain medicine. Is this going to be possible with the pins and a walking boot?

Hi Judy,
It is very important to make sure the pins are not causing the pain, because putting undo pressure on them may cause them to dislodge and then you will have problems.
Give your surgeon a call and discuss it with him. I know if you were my patient, I would want to see you.
Marc Mitnick DPM

pain after bunion removal

by Rebecca
(Houston, TX)

Two years ago I had one of my bunions removed. The doctor used a new method where he used a wire to pull the bunion in and it is held in place with a button. I can't remember the exact name of the procedure. In any case, it has been two years and even though you can't see the bunion, it is more painful now than before I had tehh surgery. I wear tennis shoes everyday, but am very active with running and pilates and the pain is becoming very bothersome. Is it possible the buinion is back or could the wire have broken? My doctor had said that sometimes they do come back, but two years isn't a very long time for them to have returned, in my opinion. I have since moved so I won't be going back to the doctor. I do have a great doctore here who performed a more traditional bunionectomy on my other foot and that one feels great. I know I probably need to go back and have him look at my other foot, but I was just wondering if you had any ideas on why the bunion pain has returned after this particular surgery.

Hi Rebecca,
You are probably referring to the "tightrope" procedure. Since the bunion (bone protrusion) has not returned, my first thought would be the pain is coming from where the button was placed. You would need an xray to see if there is a problem with the wire placement and if that is where your pain is actually coming from.
On paper, the procedure sounds great and makes a lot of sense, but I think in practice, there are numerous potential problems that were not fully thought out and since this is a fairly new procedure, the problems are finally coming to light.
If after two years you are still having problems, chances are you will need another procedure on that foot which may include removal of the wire.
Marc Mitnick DPM

swelling after surgery

I broke my 5th metatasal July 17, was in a boot (non weight bearing) until Aug 17 which then I had surgery to insert a screw. during the first month, swelling only went down during the night while elevated. for 14 days after surgery, still no weight bearing, stiches came out after 14 days, issued a walking boot: 1 week, boot and 2 crutches, 1 week boot and one crutch, then will be down to only boot, no crutch. since stitches came out, still having swelling in foot entire day. only reduced during night upon awaking after elevation thru night. still not able to put weight on without boot, swollen up to ankle daily. one week until boot comes off and back in hard soled shoes. Is this swelling normal for this long a time period?

Hi,
Swelling is a normal part of healing in foot surgery due to the dependent position the foot is in and the forces of gravity.
The question here is how much swelling is too much? That question would be better answered by your surgeon. One, because he or she is more familiar with your case and two, because if the swelling is too excessive, measures can be taken to bring it down.
Marc Mitnick DPM

still pain in my foot after foot surgery

by Carol J. Rumbaugh
(Mingo, IA USA)

Broke the sesamoid bone in right foot on Sept 7, 2007. Family doctor took xrays and advised it was just a bad sprain. Did fall Harvesting w/husband. Still hurt in January of 2008. Went back to family doctor and he thought I had gout! Wrong! Eventually sent me to foot doctor and she advised to go to foot specialist/surgeon. She took one look at xrays, did her own, and told us the sesamoid bone broke (this is where we found out that my sesamoid bone was broken and not a sprain) and had to be removed before further damage was done. Did surgery 3-25-08. She advised the bone shattered and shot up into the joint like a bullet, causing the severe pain in my foot when walking. Removed all fragments and sent me home. By mid summer the pain returned that I could barely walk. Went back to surgeon/specialist and took MRI. Found that due to the 6 months of trauma before the removal of the fragments, there was deterioation around both the ends of the toe bone and my foot bone. Went back in Aug 5, 2008 and she removed the damaged cartiledge, fused the toe to the foot, as well as using 2 titanium 40 mm screws as when she went in found that "local" deterioation of the bone had caused bone like mush inside each bone! Not good. Now, Feb 26, 2009 and my foot is to the point I cannot walk right even though I was sent to specialist for inserts for my shoes to make me walk using that right toe. It is swollen, obviously stiff, my ankle & leg are swollen at time and this is all due to the fact that I cannot walk right because fo the pain in the toe!
Question, she suggests that the "screws" come out as there is a 1 out of 10 chance that I may be allergis to the titanium metal. Is this a good idea or are we just grasping as straws?
What should I do?

Hi Carol,
Assuming the bone is adequately fused there is no reason not to take out the screws other than having to go through another surgery.
I have some problems with parts of your story. Fractured sesamoid bones do not "shoot into the joint" and if they did, it would have been evident on all the x-rays prior to the first surgery. Other parts of your story also sound fishy. I find it surprising that there seems to be a new problem every time your foot starts to hurt again. I do not know your age but I am wondering why your surgeon performed a fusion at the joint instead of putting in an implant. (I am keeping in mind that I am only getting your portion of the story and not your doctor's as well). But based on all this you really need to get another opinion as I cannot actually examine your foot, a qualified footspecialist needs to look at you and offer an opinion. I would recommend this before consenting to any additional surgery.
Marc Mitnick DPM

pin removed from toe came out bent

by lois
(sacramento, ca)

I had a bunionectomy/hammertoe surgery 5 weeks ago and dr removed the pin from my toe. The pin was bent as I did walk on side of my foot, very little. I am wondering if I damaged something as a result.

Thank you,

Hi Lois,
Probably not if the toe appears straight and your doctor did not seem concerned. An xray would indicate if there is any problem.
Marc Mitnick DPM

Persistent Foot Pain After Two Bunionectomies....

by Nathalia
(USA)

Hi, Doctor!

I had 2 McBride Bunionectomies- January 2005 for the right foot, and June 2005 for the left foot. In addition, I had three screws put in each foot to help the bone heal properly. My doctor never prescribed physical therapy although both feet had been in casts for 2 months each. I would have never imagined how painful it would be to learn to re-walk. He merely told my fiance to rotate the foot and move it back & forth, but it was SOOO painful, that it was impossible. Not to mention, he was the type of doctor that was VERY "no no" about giving medication for pain. I did wear a bootie and use a cane for some time, but quickly had to return to work in NYC, and if you can imagine, it was pretty hard keeping up with the flow of walking traffic. After the booties came off, that's when I noticed that I had very poor coordination standing, and up until today, I do not have good coordination when it comes to standing on one foot.

After complaining to my doctor that my feet were in excruciating pain, he merely stated that I was hypersensitive and that it would get better with time. That was pretty much the last correspondence between us- as he stopped returning my calls, and if I went to his office, his secretaries would always say he was in with a patient (even if I could see him down the hall).

After about four months of pain I could not handle (and without medication- even though I requested many times for something to help alleviate the discomfort), I sought a second opinion. THANK GOD!!!

The second doctor quickly did a few examinations and x-rays and found that the screws were wound too tightly and they were pressing against my nerves. The second doctor clearly stated that had I not done anything about it, I'd be going through excruciating pain for the rest of my life, because bundles of nerves were being pressed against and there was NOTHING that could alleviate that except removing them. And that's exactly what was done. On January 2006, I had surgery on both feet at the same time. It was very painful and hard to become dependent on others for everything as I couldn't even stand, but within about a month, I was up and walking again in NYC.

It's been more than 3 years now since my initial surgeries, and I STILL have a pain that neither doctor could help with. Pain at the sight of incision. It's VERY sensitive, painful, it feels like what sheer pain would feel like- my goodness! Please note that though the first foot done is extremely sensitive to the touch, the second foot done is the MOST painful. I'm 29 years old, very healthy, no allergies or other health problems. I don't wear heels, only wide sneakers and flat linen shoes that don't press on the incision sight. Any medicine that has been used to help this, as different doctors and even my neurologist tried to find the cause- which they say it MIGHT be nerve damage, but they have no tests for the area where it hurts most. I've had X-rays, MRI's, nerve tests, you name it. What was supposed to help make my painful bunions go away merely replaced it with a different type of pain that is, honestly, consuming my life. When I'm in the shower, the water falling hurts the incision area of my feet, and when I sleep, I have to wear socks because even the sheets make it extremely uncomfortable! So please note that the pain goes all the way down from the bottom of my big toenail to about the middle of my foot (see photo).

ANY advice you can provide would be EXTREMELY appreciated! Tests that can be done, meds, anything! I don't want to live my life like this, and the pain is the same as when the sutures first came off!!!!

Hi Nathalia,
If I understand you correctly, your pain is now located at the site of your previous incisions. Many times there can be excessive scarring in the incisions which entraps the local nerves making for a heightened sense of pain. Have you had any cortisone injections into the incision sites? That would be the first thing I would consider. If that does not help and your pain is truly from the skin incisions, then I would consider having the incisions (scars) removed and re-sutured possibly by a plastic surgeon.
Marc Mitnick DPM

Gap/loss of bone following surgery to internally fixate 5th metatarsal fracture

I broke my fifth metatarsal on June 21st, 2009, and due to non-union following conservative treatment with two weeks of no weight bearing and 6 weeks of weight bearing in a boot, I had surgery to internally fixate it with a plate and 5 screws on August 26th 2009. A DBX bone matrix was used to assist with healing. I returned for follow-up 6 weeks post surgery, and the x-ray revealed that there was still a large gap where the bone had not filled in. The fracture was a spiral fracture which occurred distal to the base of the metatarsal in the middle of the shaft, radiating laterally. I was advised to continue to use crutches and non-weight bear for 4 more weeks and then return for another follow-up appointment. Could you please advise me as to why the bone might not be healing, what happens if the bone does not heal and what I could do to encourage healing. Thank you.

Susie

Hi Susie,
I do not know enough about you to offer an opinion as to why you are not healing but I would recommend that you ask your surgeon about trying a bone stimulator. It has only been about six to seven weeks since your surgery so technically this surgery would not yet be considered a failure.
A bone stimulator may go along way to expediting the healing process.
Marc Mitnick DPM

Redness and swelling of foot 3 weeks post recurrent neuroma surgery

Three weeks ago I had surgery to remove and repair a recurrent neuroma on my left foot. The first surgery was in March and the doctor went in through the top. The second surgery was from the bottom. Incision is healing nicely. I was told to stay off my foot (absolutely no weight bearing for three weeks. Have followed this but am now starting to experience something odd. When I sit at the table for any length of time my foot gets very red and swollen. Is this normal? If yes, what's happening and if no, what should I do?

Hi,
If your symptoms are first starting now, after three weeks, they might not be normal findings. Your surgeon is responsible for you well being even after the surgery. Speak to he or she about your symptoms.
Marc Mitnick DPM

foot pain after fusion

by Bonnie
(Indianapolis)

I appreciate the reply I got from Dr. Mitnick. I have done therapy but it seems
like that the pain is just very rough at times. I can't walk but hobble
around, and have the swelling. The swelling is severe enough that I can't
even get my shoes on at times.My Dr is going to see me today at 4. The pt
said that the Dr is often times done with patients after they have done the surgery. Seems like the pain is severe at times other times not bad at all. Please help.

Hi Bonnie,
Whether the doctor likes it or not, he or she's responsibility extends beyond the surgery. If the pain you are having is the result of the surgery then the surgeon is responsible and must deal with the consequences. Hopefully your surgeon understands this responsibility and will act accordingly.
Doctors do not "walk on water" and we make the same amount of mistakes that every one else makes in our every day lives.
A different follow up approach may be needed in order to get you pain free and the best judge of that is the person that operated on you.
Do not settle for anything less than that.
Marc Mitnick DPM

Toes are very tender to touch 2 weeks after surgery for Morton's Neuroma

I had a neuroma excised between my 3rd and 4th metatarsals on my left foot. The incision seems to be healing OK but my 3rd and 4th toes are very tender to touch and I have occasional tingling shooting through those toes. My doctor has me taking an antibiotic in case it's beeing caused by an infection. Is this normal and will it go away soon?

Hi,
Although you could certainly develop an infection, tingling is not one of the symptoms of an infection.
To me, tingling means nerve pain. It may be nothing more than irritation on the remaining nerve from the post op swelling or in a worse case it may be that he did not remove enough of the nerve.
Make sure your doctor stays on top of this and keep him posted on your progress, AND follow all his instructions.
Marc Mitnick DPM

Recovering from surgery after repair to tailors bunion

by Ronnie
(Phoenix, Arizona)

Hi my name is Ronnie, I Rohad surgery to remove a tailors bunion, I had a ex-ray done on my second visit after the suregary and the doctor tells me that the screw he put in the bone to hold it in place came out. How long will the bone take to heal with the crew holding it together, and will it heal properly?

Hi Ronnie,
If the screw came out, then it has to be removed. Secondly without the screw in place the fractured bone may not heal properly depending on the alignment.
Typically these types of procedures create unstable osteotomies (fracture sites) and need to be properly maintained.
You really need to speak to your doctor and see what he or she recommends.
Marc Mitnick DPM

toes discoloring a week after bunionectomy

by Tina
(Lodi, Ohio, USA)

I am one week post op for a bunionectomy on my right foot. I have been off my feet and keeping them eleveated as directed until today. I had a mandatory meeting at work and was unable to elevate as much and had to stand wuite a bit. Tonight my foot is swollen and my the toes are turning black. I still have feeling and dont seem to have excessive pain. Is this normal and just from being on them too much today, or should I be alarmed?

Hi Tina,
Your surgeon should be the one to determine if this is a problem or not, but I will tell you many patient's will have toes that turn black and blue after foot surgery, but since I cannot actually examine you, alert your doctor and let he or she decide if it is anything to be concerned about.
Marc Mitnick DPM

problem 1 year after bunion surgery

by Melody Spence
(Opelousas, La)

In Jan of this year I had bunion surgery with 2 screws put in the large toe. I had a lot of problems with swelling the first three months. Ever since then it feels like I am walking on a marble in the ball of my foot. I have somewhat learned to walk on the side of my foot as it is uncomfortable and causes a lot of problems finding shoes that fit now. It feels like something is starting to stick out of the bottom of the bones in the area of the ball of my foot. That foot is thicker and is causing trouble finding shoes that fit both feet. The surgery visibly is a success but is almost as bothersome as the bunion.

Hi Melody,
I do not know why you are having pain in the ball of the foot when screws were put in the toe, but the best advice I can give you is to go back to the surgeon. The surgeon's responsibility to you did not end on the day he or she performed surgery. It is the surgeon's responsibility to treat any complications that should arise.
Marc Mitnick DPM

Fused at the wrong angle

by Barb
(Albany)

In addition to the too large hardware, I have been told that the angle of the fusion was incorrect due to foot drop not being taken into consideration. Thus the pain. My foot can't lay flat so I am putting most of the pressure on the third toe that has developed a painful callus or wart depending on who I ask - dermatologist vs. podiatrist.

Can fusions be undone? What is involved?

Hi Barb,
Most fusions can be undone; it involves re-breaking the bone and fusing it again (in a different angle).
Marc Mitnick DPM

Knots on bottom of feet after bunion surgery

by Jill
(Georgetown, Texas)

I had bunion surgery 6 weeks ago and developed a knot on the bottom of foot after wearing flat post-op shoes. I also have one on the other foot and developing one under the big toe. What is it? Will it go away? One doctor told me to wear tennis shoes. That he feels I have aggravated the bone. Please help. Is this normal after bunion surgery?

Hi Jill,
I do not see how this is related to the bunion surgery as you have these "knots" on both feet and I assume you only wore the flat surgical shoe on the foot that was operated on.
Since I cannot visually see the knots, I have no idea what they are.
If your surgeon is not giving you a satisfactory answer, see another doctor.
Marc Mitnick DPM

I had bunion surgery. Now I have a knot on bottom of foot.

by Jill
(Georgettown, Texas)

I have a knot on the bottom of my foot. I had bunion surgery about 5 weeks ago. The knot is painful. It is on the ball of my foot (fatty part of foot) between second and third little toes.

Hi Jill,
The area of the foot you describe is where one of the sesamoid bones is located. I do not know what kind of bunion procedure you had but many times "work" is done on the sesamoid bone.
This is something that needs to be brought to the attention of your surgeon as it is not a normal finding.
Marc Mitnick DPM

Need ankle revision sugery for misaligned fibula bone

by Donna
(Florida)

I had sugery for a broken ankle OS said break was not bad but leg was misaligned with my foot.Now after 2 1/2 months he said I need a revision because leg is still misaligned there is a big gap between the bottom of my fibula and my ankle he also said he has never seen this before he tighten the tendons but that did not work I am so scared he said he may have to rebrake it. Please any advise?

Hi Donna,
The best advice I can give you is to go get a second opinion by someone who can examine you and look at the xrays. You do not mention if you are having pain or not. If there is no pain this is not an emergency situation, so have the second doctor give you all your options and then decide what is best for you.
Marc Mitnick DPM

extreme ankle pain after charcot foot reconstructive surgery-swelling, swollen, red, warm, can't bear any weight

Last Aug I discovered I had severe Charcot foot. My doctor did reconstructive surgery with 4 fusions. Previous to surgery, there was an area of pain in the ankle which was dislocated. One year later, I recently have extreme pain, cannot bear any weight, foot swelling, red and warm. I've been icing, elevating, and not walking on foot and 1 1/2 weeks later, continue with same symptoms including excruciating pain.

Hi,
Unfortunately Charcot foot surgery is not a straight forward procedure and can be filled with complications.
You would be wise to bring your concerns to the attention of your surgeon, or perhaps get a second opinion.
Do not be quick to have a second round of surgery (unless there are no other options) as you may find your self in a spiral of repeated surgeries with each subsequent surgery leaving you worse off than before.
Marc Mitnick DPM

toes and part of foot turns purple/red and feels very cold after bunionectomy

I had a bunionectomy on dec. 22nd (with 2 screws and a metal pin), it is now jan. 9th. The doctor says everything is healing nicely. I don't have too much pain anymore. I am putting weigh on my heal now per the doctor. My only question is that when i stand up the top of my foot and all my toes turn a red/purple color and are VERY cold. Is this normal or should I be concerned?

Hi,
The color change does not concern me as much as the fact that the foot gets very cold. You need to bring this to the attention of your surgeon so he or she can determine if there is an issue with your circulation, or if you are wearing a cast, whether or not it is too tight.
I would do this sooner rather than later.
Marc Mitnick DPM

Pain after 2 of 3 surgeries

by KR
(San Diego, CA)

I had osteotomy in Jan 2009 and bunionextomy. Foot was stiff, sore and 2nd and 3rd toes tingled and burning and numb. Had secon surgery this August. The doc took out scar tissue, the pins and cut out two jagged nerves. Now, huge lump is on bottom of foot (very painful like stepping on glass. 4th toes is burning and toes 2-4 feel tingles (when touch lump on bottom of foot. Toes are purple and I have feeling of rubber band around toes 2-4. Doc wants to ct me open again to see what is causing lump (does not think fluid as it is hard). Had two cortisone shots and that helped but hurt like anything. What do I do?

Hi KR,
You get a second opinion. Each time this doctor has operated on you, he/she has made you worse. You may require additional surgery but it would make sense to hear that from another expert.
Marc Mitnick DPM