Pain after bunion surgery

by Ann
(Charlotte, NC)

I had bunion surgery on my right foot in March 2017. Approximately 4 months post op, I started have pain along the bottom of my foot (2nd and 3rd metatarsal heads). I had pain in my 2nd toe after surgery and told my surgeon 6 weeks post op. He said that was normal since he reattached a ligament. It's not a sharp pain but more of an ache especially if I move or bend it. I've been back twice....had X-rays, diagnosed with metarsalgia and had an injection in the joint of the 2nd toe. I've also had custom orthotics which I feel make the pain worse. The pain has not diminished. My doctor suggested shortening the 2nd metatarsal bone. After some research, I don't feel more surgery is an option.

I can feel a hardness and thickening around my big toe and going to PT. I cannot walk barefooted at all and have pain after walking 1 mile. Are there any other treatments recommended for this problem besides surgery.? Since i''ve had normal X-rays, is a MRI suggested?
Thank you

RESPONSE

Hi Ann,

In general post op foot surgery pain can last upwards of a year, with the knowledge that each week the pain will diminish a little bit more. Apparently at 13 months you are still having issues.

The first thing that comes to mind is the type of bunion procedure you had done. Based on the fact that you have metatarsalgia on the second and third metatarsals leads me to believe that you had some kind of osteotomy, where the first metatarsal bone was broken and re-fixated with screws, k-wires or some other kind of hardware.

If you did have an osteotomy, then that would explain why you are having metatarsalgia pain, simply because the osteotomy shortens the first metatarsal and then puts additional pressure on the other metatarsals. That is also why your surgeon now wants to shorten the second metatarsal.

You also mention the surgical site still hurts. You should have gone for physical therapy after the surgery, not 13 months later as physical therapy is more effective immediately after surgery.

The hardness or thickening you feel around the big toe may be any hardware that was placed in your foot or you may have scar tissue build up.

I would be curious to know if the big toe bends upwards or is there limitation of motion in that joint. I would also be curious as to your age and level of activity.

I am of the mindset that further surgery to fix problems that occurred with the original surgery, in general leads to other issues. I have seen too many patients over the years who keep going back for foot surgery to correct problems with previous surgeries, only to end up crippled. So, even though I have not examined you, I would be reluctant to jump into further surgery.

Orthotics are used for metatarsalgia and usually are very effective. I do not know what type of orthotics you have, but in general, to correct metatarsalgia, they should not be uncomfortable.

Although, based on your narrative, your problems appear to be structural (the way the bones line up) the fact that you complain of a hardness and thickness in the big toe joint might warrant an MRI to get a better visual of what is going on with the soft tissue structures in that area.

To sum this up, at thirteen months, if you are still in significant pain, then perhaps a second opinion by a surgeon in your area might be your best option. You need an opinion by someone who can physically examine you and review both pre-op and post-op x-rays.

Marc Mitnick DPM
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