pain in the toe next to my big toe

by SHIRLEY
(DALLAS TX)

I had surgery 2 years ago and my doctor did a bone graft because arthritis had eaten a hole in my metatarsal. I was having a lot of pain when I drove or play the piano (the right foot pushed the pedal similar to a car pedal). He used a plate with pins and screws. It took 13 months for the incision to finally heal. Now I am having a similar pain in this foot again. Should I be concerned?

RESPONSE

Hi Shirley,

Should you be concerned? That would depend on how long you have been experiencing this new pain and of course how intense the pain actually is.
I phrase it that way because when people start having hardware inserted into their bones it is rare that they do not experience some degree of discomfort from time to time.
Now, if you have noticed an increasing incidence of pain and the pain seems to be getting worse, then yes, I would be concerned if I were you.
Since you were having arthritis type pain that tells me that you were either having pain at the base of the second metatarsal, which is rare, or the head of the second metatarsal which would be a more common place to have pain (from arthritis).
In any event there is a good possibility that it is the hardware that is causing your new found discomfort and if your surgeon determines that to be the case, then one option would be to remove the hardware as it is two years since the surgery.
If that does the trick, then fine, you are done. If your surgeon determines that it is the actual bone and joint then you may have issues.
This could pose a problem simply because if you require more surgery in the same area, it gets increasingly harder to correct an "already corrected problem" due to issues like previous scarring, or the fact that the metatarsal bone will be of poorer bone stock to work with it, plus the actual joint is probably further worn out.
The fact that you did have a period of time where apparently you were pain free (other than a ridiculously long healing time for the incision) that tells me that the bone graft worked and your surgeon achieved his desired results.
Also keep in mind that screws can become loose and if that is your case then the plate may loosen ever so much and that too could be your source of pain.
So, in summary I think your guidelines should be, if you are noticing a worsening of pain both in duration and intensity, than a trip to your doctor would be mandatory. If your pain is occasional discomfort followed by periods of being pain free, although you can run that by your doctor, it does not sound like there is any sense of urgency.
I will let you decide which category you fall into.

Marc Mitnick DPM
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