I have a hard bump behind the joint of my big toe

by Melissa
(Coram, NY)

About 15 years ago I had surgery on the toes on my left food because of a bunion. I haven't been able to bend my big toe since, but I can move it by hand and when I do it makes a clicking noise like it needs to crack, but it won't.

Over the past few months I started getting a really bad pain behind (bottom of the foot) the big toe, and eventually realized there is a hard bump underneath the joint. It's not skin, it feels more like it could be bone? It sometimes gets worse depending on the kind of shoes that I wear. I'm going to a podiatrist in a few weeks, but I was just wondering your opinion on what it could be (I'm having a hard time researching) and possible solution? I'm a little worried about needing surgery again!

RESPONSE

Hi Melissa,

In general, people do not get bone spurs on the bottom of the big toe joint as it is much more common on top of the joint.
Because you have had surgery on the bunion joint, anything is possible. I would like to know what kind of bunion procedure you had. In general in a simple bunionectomy there is no "work" done on the bottom of the bone so the chances of the surgery having caused this bony prominence, even 15 years later is not likely.
In the more involved bunion procedures where the first metatarsal bone is surgically broken, re-angled and re-set, there is the potential for problems down the road.
In these more involved procedures some type of hardware is usually implanted to hold the re-angulation in place. This would include screws, screws with plates, along with wires. I am also assuming here that you did not have an implant (artificial joint) performed on the bunion.
If there is hardware implanted in the foot, over time it can loosen up, particularly screws and they can start to back out and feel hard against the skin. I have to mention, though, that most screws used in bunion surgery are placed through the top of the foot, so if they were to back out, you would notice a lump on top of the foot, which is not your situation.
In addition when a bone is surgically broken in an effort to re-angulate it, sometimes the fractured ends of the bone will overgrow new bone as the bone heals and people can feel a lump, which is actually more bone than should have formed. In most cases, this phenomenon will occur long before 15 years, usually a few years after surgery.
The possibility of a bone chip from the previous surgery could also be occurring but once again I would think you would have noticed this long before 15 years.
The last thing that comes to mind may be a sesamoiditis. You can read about it by finding it on the navigation bar to the left.
The sesamoid bones are two small bones that are just underneath the big toe joint. Because of their location they can become painful. In some situations as people lose fat on the bottom of the foot as they age, the bone becomes more prominent and can be become painful. Pressing on the area will give the feeling of pressing on bone as well as pain.
Obviously, I am just making educated guesses here and the fact that you are going to see a foot specialist in your area is the right thing to do.

Marc Mitnick DPM
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