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The response to the question below was authored by Marc Mitnick DPM

Pain in 2nd toe post op. - bunion surgery

by Ann
(North Carolina )

Hi Dr Mitnick,

I had bunion surgery (osteotomy/chevron cut) on March 2017. Since the surgery, I've developed metatarsalgia at the level of he 2nd and 3rd metatarsal heads( 2nd being worse). It's very uncomfortable to walk barefooted or with any sandal that doesn't have added cushioning. Running is no longer an option and walking more than a mile causes discomfort. I've always been very active, working out 5 days per week. I've had to modify my workouts. I do have custom orthotics and try to wear them as much as possible but still have some pain. I've had pain in my 2nd toe when wiggling it and pushing it towards the floor. Not so much pain when bending it up. I have very good motion in my big toe. I noticed this and asked my surgeon about the pain in my 2nd toe six weeks post-op. He mentioned reattaching a ligament. His PA also mentioned this during a follow up visit. Now the 2nd toe looks to deviate towards the big toe. There has been some concern that this may get worse and may result in a hammer toe. Is this common after bunion surgery and any suggestions on resolving without surgery?

All X-rays have been normal and my MRI is normal but showing my 2nd toe deviating towards the big toe. I've had 2 injections in the joint with relief for approximately 1 month but the pain along the bottom of my foot (2nd and 3rd metarsal heads) always returns. Even if I wear my custom orthotics and walk for more than a mile, I still have pain. I got a 2nd opinion and he suggested surgery to shorten the 2nd metarsal bone and re-align/straighten the 2nd toe and possibly put a pin in it (this will be removed 6-8 weeks later.).

I'm very nervous about the surgery and don't want to jump into it if there are other options. The physician that provided the 2nd opinion didn't immediately suggest surgery and was honestly hoping the MRI showed something to explain the pain in my 2nd toe.

I appreciate any advice.
Thanks!

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Oct 29, 2018
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by: Dr. Mitnick

Hi Ann,

Without actually examining you and seeing all your imaging studies, I am afraid I cannot be of any more help.
My suggestion, go with the advice of the doctor who explains everything to you and appears to genuinely care about your wellbeing.

Good luck.
Marc Mitnick DPM

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Mayo Clinic

Johns Hopkins Medicine

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Arthritis Foundation

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Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Orthotics for multiple types of foot pain best buy in a pre-made orthotic click link below

Orthotics for heel and arch pain for those who must wear dress shoes click link below

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Unknown location

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Dear Marc

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Wonderful advice

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This is the best site for foot problem info.

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location unknown

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Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

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Pain in 2nd toe post op. - bunion surgery

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