pain in both feet sending pains to calfs after bunionette surgery

by sarah
(uk)

i had surgery to both feet 12 weeks ago for bunionettes.i am experienceing severe pain along the side of my foot from the fifth toes where surgery was performed.it has now gone to the calfs of my legs it is hard to stand straight bend walk...so in pain all the time.i was told i have tight ligaments/tendons from the heels up..and torn tendons on the side of feet by the ankle bone..is this my body reacting to the screws that were implaced to support my toes...painkillers resting dont seem to be helping me at all.

RESPONSE

Hi Sarah,

Well....by twelve weeks post surgical correction of tailor's bunions you should have been well on your way to recovery and apparently you are not.

I am assuming you had the same procedure done to each foot. The fifth metatarsal head was surgically broken, realigned and held in place with screws.

The first problem I have is that it sounds like you had both feet done at the same time. Although many surgeons do bilateral procedures at the same time, I am a big proponent against this, particularly when an osteotomy (surgical breaking and resetting of bone)is being performed on both feet.

Call me cautious, but when I do an osteotomy and fixate it with hardware, I also put my patient is a walking cast for a few weeks in order to protect the surgical fixation. Simple walking puts a tremendous amount of pressure on the osteotomy and there are many variables which may lead to problems.

Among those would include too much walking, in spite of warnings from your surgeon, being overweight adds excessive pressure on the foot. I do not know your age, but if you are older and there is some degree of osteoporosis, that will weaken the fixation site and may cause problems. The actual screw fixation may not be perfect and so there could be an inherent weakness in the actual fixation. This is just an example of some of the potential problems.

So by putting the patient is a walking boot we can mitigate some of these issues. But, by doing both feet at the same time, you lose the ability to use walking boots as you cannot wear a walking boot on both feet at the same time.

Furthermore, because you have had both feet done at the same time, obviously you are naturally walking gingerly on both feet and that abnormal gait can also add to the problem.

Having said all that, I would assume you have had some recent x-rays and I assume if there was a problem with the bone healing process, your surgeon would have made you aware of this issue.

Since I do not have access to your x-rays I do not know at what angle the screws were placed, but in most instances the small muscle on the outside of the fifth metatarsal bone has to be dissected away in order to place the screws and then it is sewn back into place. Irritation to this muscle may be causing pain on the side of your foot, or, you may actually be having pain from the osteotomy site and your surgeon is not being completely honest with you.

I bring this up because for the life of me, I do not see how all of a sudden you have "torn tendons" on the outside of your ankles, particularly if you are being told that is occurring on both feet. Unless you were in some kind of accident, the chances of having torn tendons on both feet at the same time is almost nil.

You may actually have tight Achilles tendons on both feet and yes that may be part of the problem, particularly if you had been wearing a surgical shoe, those flat, hard bottom shoes. They can aggravate the Achilles tendon and cause pain in the back of the leg.

I would suggest, because you had surgery, and I know nothing else about you, the possibility of a phlebitis does exist, which is a blood clot in the veins behind the legs and that too could cause pain. A doctor should at least rule that out as that is potentially a dangerous situation.

I realize I am only getting your narrative on what is going on but something does not sound right to me. Even if there is no problem going on and in spite of having both feet done at the same time, which slows down healing, by twelve weeks you should be feeling much better, not worse.

My suggestion would be to get a second opinion from a different surgeon, someone not associated with the first surgeon. A surgeon who had nothing to do with the original surgery would be more inclined to give you a more honest assessment of what is going on.

Marc Mitnick DPM
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