Pain @ the base of 2nd & 3rd toes Left foot.

by Alan
(Los Angeles)

This started as I was walking on a golf course about 3 months ago.

1st podiatrist took an ex-ray, but didn't offer any explanation.
2nd podiatrist pointed out a what looks to be a bone chip lodged in the joint.

What is the best, least invasive procedure to remove the chip?

Thanks.
Alan

RESPONSE

Hi Alan,

I would actually have to see the x-ray to really be able to give you a definitive treatment plan. In any event let me discuss the two possibilities.
The first would be where the bone chip is disengaged from the main bone, either the metatarsal head or the base of the toe bone (proximal phalanx).
If the bone chip is broken from either site but still partially attached then there is the possibility that the bone chip could heal itself back to the main portion of bone.
This would be accomplished by complete immobilization of the foot for at least six weeks, possibly longer depending on a number of factors such as your age, the density of the bone, whether or not you are a smoker, perhaps a diabetic or a few other medical issues that may preclude the bone from healing. If this is your situation then you could try complete immobilization with the knowledge that it might not work. That would be your best case scenario.
Your worst case scenario is one where the bone chip is totally disengaged from the bone and is sitting freely in the joint space. Its movement is acting as an irritant and thus is giving you pain when you walk.
In this situation your only logical treatment is removal of the bone chip.
As far as I know there is no arthroscopic procedures available for problems with the metatarsal-phalangeal joint, simply because the joint is too small.
So in order to have the bone chip removed, the joint would have to be opened, the bone chip identified and then removed.
Yes, it is an invasive procedure but in the grand scheme of things, this should be the worst surgery you ever have to face.
By that I mean it is not a terribly involved procedure. The actual procedure should take no more than twenty minutes and the recovery period would be relatively quick.
Since no bones are being remodeled (other than removal of a small chip) and no soft tissue is being removed (such as a ganglion), then there should be minimal restrictions put on you during recovery.
Sutures stay in for two weeks and so you will not be on the golf course during that time; in fact during that period until the sutures come out, your goal will be to keep the surgical site clean as potential infection is your biggest concern.
You will be able to walk and should not be on crutches. You will just have a dressing and a surgical shoe.
Since it is your left foot, it will not impact your ability to drive unless of course you have a clutch in your car.
The only thing that concerns me is whether you actually have a bone chip as the first podiatrist did not notice it.
You do not need a medical degree to understand what a bone chip is, so if the second podiatrist actually pointed it out to you, then you may assume it exists.
I think the best advice I can give you would be to get one more opinion from a local doctor in your area to confirm the presence of the bone chip. You certainly would not want to undergo surgery if a bone chip did not actually exist.

Marc Mitnick DPM
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