Pain 7 months after cheilectomy

by Jamie
(London, Ontario, Canada)

Had a cheilectomy 7 months ago and left foot a little stiff but well recovered, but right foot still has burning pain in ball of foot under big toe all of the time. I did break this toe three months prior to my already scheduled surgery in January. Wondering if the prior injury has anything to do with my right foot not recovering as well as my left and if this pain will ever go away or if I might need to have further treatment or just live with it?

RESPONSE

Hi Jamie,

Since a typical cheilectomy usually involves removing bone spurs typically on the top of the first metatarsal bone and in some cases the top of the base of the toe, it would seem to me that the pain you are experiencing on the bottom of your toe is not related to your surgery.

The only connection I could possibly make is perhaps if your great toe joint was so arthritic that further surgery was necessary to remove bone spurring that may have been present on the inside and outside of the metatarsal bone and big toe bone. This extra dissection may have done some damage to the bottom part of the great toe that may have lead to a problem on the bottom of the toe.

If that was not the case then it would seem to me that any pain you are experiencing on the bottom of the toe may be the result of the fracture that you sustained.

I guess the question that should be asked is, did the toe bother you on the bottom just prior to the surgery, or did it occur after the surgery? In other words, was the burning present prior to your foot surgery?

If your answer is yes, then you can assume the burning is related to the broken bone, if your answer is no then it must somehow be related to the surgery, but as I already mentioned, simple cheilectomies generally do not result in burning pain on the bottom of the toe, unless there was dissection performed on the bottom of the toe.

Burning is usually but not always suggestive of nerve pain and again if one of the local nerves in that area was damaged during surgery that could cause burning.

The other concern would be possible damage to the sesamoid bones which are two small bones found underneath the first metatarsal bone and if enough extra dissection or even retraction (holding tissue apart for better visualization), there might have been damage to the sesamoids.

In most cases where there is a suspected fracture that may have not healed and is not evident on x-ray, a bone scan can be performed which may show fractures that an x-ray fails to reveal.

The problem here is that we generally avoid bone scans in areas where there has been recent bone surgery as a bone scan may come back "hot" meaning there is osteoblastic activity (bone growth) that would be seen in fractures, BUT, recent bone surgery could also cause a bone scan to come back with the same result, because the metatarsal and great toe bone would also be remodeling themselves after the spurs were removed.

So I think your next best option would be an MRI, which should also show an unhealed fracture and may also show any problems with the sesamoid bones as well as the ligaments that attach them to the metatarsal bone.

I think the MRI is justifiable because at seven months post op for this type of procedure you should be well on your way to being recovered meaning you might not be perfect, but you are not having major issues; in your case, you are not.

In order to find out whether you will need further treatment or whether you have to live with it are predicated on two factors. The first is you have to find out what it causing the burning and whether or not it is treatable. Secondly, you have to decide how much this problem bothers you and whether it is worth whatever further treatment is offered to you.

Marc Mitnick DPM
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