Pain like an electrical shock in the ball of my foot next to the big toe following bunion surgery.

by Michelle
(California)

I had bunion surgery and had no problems at first. Starting about 6 months ago I began to have a sharp electrical shock like pain in the region of the surgery. It is most pronounced when I bend down to touch my toes with straight legs (doing yoga). Can anything be done about this?

RESPONSE
Hi Michelle,

The first thing that comes to mind is nerve pain as the feeling of an electrical shock is generally due to nerve irritation.
In most cases of this nature the electrical shock sensation is usually on the top of the foot. What happens during this type of surgery is that one of the superficial nerves (the sensation nerves) is either accidently severed which would cause this sensation almost immediately, or the nerve is identified and protected but as the healing process ensues, the nerve gets caught in scar tissue and the nerve becomes irritated and begins to give off the electrical shock sensation.
Now, you mention your symptoms are on the bottom of the foot.
The very nature of touching your toes with your legs straight would have the effect of "stretching" structures on the bottom of your foot and thus in your case, exacerbate your symptoms as you are putting tension on the nerve and if the nerve is caught in scar tissue, the nerve does not stretch and you end up with your symptoms.
You do not mention what type of bunion procedure you had performed. More aggressive procedures require more dissection particularly on the bottom of the foot. When we surgically break a bone in order to realign it, the saw blade might have done some unknown damage to the soft tissue structures on the bottom of the foot and that may have impacted one of the nerves on the bottom of the foot. Quite honestly, it is difficult to know exactly what happened particularly since I was not there.
In any event there are things that can be done. A cortisone injection into the exact area where the electrical shock is coming from may go a long way in reducing the inflamed nerve and stop your sensations. Whether the result is of short term or permanent remains to be seen.
A second option would be multiple injections of what is known as 4% denatured alcohol. The purpose of this type of injection is to "deaden" the nerve so that you do not get the electrical impulses that you mention. Once again the injection would have to be directly into the offending portion of the nerve.
Cryosurgery, where a probe is inserted into the area where the nerve is entrapped and then the affected nerve is "frozen" might also be an option to explore.
You are six months down the road, but physical therapy in an effort to break up the scar tissue might also be of benefit. This could be done in conjunction with either type of injection.
When the nerve irritation is on top of the foot, it is relatively easy to re-open the incision and search for the entrapped nerve, free it up and close the wound. An entrapped nerve on the bottom of the foot might be another story. Depending on the nerve involved, it might be possible to go through the original incision and dissect down to the nerve if the entrapped part is not directly under the bone. If the entrapped nerve is directly under the bone, an incision would have to made on the bottom of the foot, which we all try to avoid, due to concerns about skin scarring, but that might be the only way to get to the nerve. In this case you would have to weigh the risks versus the potential reward.
So, yes there are things that can be done, but the best advice I can give you is to see your surgeon, let he or she know what is bothering you and between the two of you come up with a plan that makes sense.

Marc Mitnick DPM
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