post operative foot pain.

by Jeanne
(Santa Rosa, CA)

I had surgery on 3 toes of my right foot in Feb. 2014 - 5 1/2 months ago. I had a bunionectomy with pin inserted for my great toe. My second toe was arthritic and the

arthritis was removed and an implant inserted. The bone on my fourth toe was shaved due to overlap. I was compliant and not weight bearing for 8 weeks. My foot felt pretty good at that point. However, I still have swelling and pain in the arthritic toe and the fourth toe is still discolored. I am unable to detect any improvement it actually seems to be worsening. My surgeon is one of the best. Examination of xrays by both my surgeon and a month ago by another ortho did not reveal any problems. I just turned 65 and am NOT overweight. Prior to the surgery I walked 5 miles/day. I now am able to walk only 3 miles every other day. I am not happy - I cannot maintain my formerly active lifestyle.

RESPONSE

Hi Jeanne,

Sometimes the best procedures performed in the hands of the best surgeon does not result in a satisfactory result. This is one scenario you will have to entertain and hopefully prior to your surgery, your surgeon made you aware of the fact that you could actually be worse off as a result of the procedures you had performed on your foot.

However, all may not be lost. I am assuming your bunion correction is fine as you do not mention having any pain with that procedure and you just state you are having issues with the second and fourth toes.

The second toe is a unique toe compared to the other toes. Any surgeon who does regular foot surgery will tell you that the second toe has a higher propensity to swell and stay swollen, more so than any of the other toes. Why is this? I have always been of the understanding that it has to do with the lymphatic system or the drainage system of the body and for some reason the second toes does not drain as well as the other toes, so it tends to remain swollen.

Working against you is the fact that you had an implant placed in the second toe. I have never been a big implant fan for toes as I think it is over-kill and quite frankly, you place an implant in a joint when you want to be able to create pain free of motion. The problem with joints of the toes is that they do not really go through a range of motion and so just removing the arthritis (arthroplasty) without an implant is usually enough.

I would also venture to guess that the implant may be contributing to the toe swelling, but I could be wrong.

The other think working against the second toe is that it is summer time. I assume it is hot in California.

Feet normally swell due to heat and certainly parts of the foot that have been operated on will tend to swell more. This too may be part of the reason your second toe is swollen. The good news here is that usually once cooler weather arrives, the swelling diminishes.

I do not know what you mean by your fourth toe being shaved because it over-lapped. Usually in an over-lapping toe, we straighten it by fusing it after removing some bone to put the toe in a straighter position. So, are you implying that your fourth toe now hurts more than it did prior to surgery?

If you are noticing that your second and fourth toes are not too swollen first thing in the morning but swell as the day progresses than all may not be lost.

What I do with my patients, actually as soon as the stitches are removed, is to have them purchase one inch coban rolls. This looks like miniature ace bandage material. First thing in the morning I have them wrap the toes, individually, under moderate tension.

This will do two things for you. It will keep the toes from swelling during the course of the day and should make it more comfortable for you to walk as a wrapped toe will less likely be painful as you ambulate.

Although it is over five months since the surgery, you might ask your doctor about physical therapy which can be helpful in reducing the swelling in the toes.

A cortisone injection, although it may be painful, might be very helpful in reducing the pain and some of the swelling in the toes. Again, speak to your doctor.

Lastly, if none of this works out for you, it might not be a bad idea to consider having the implant removed.

As a final point it should be noted that bone surgery can take upwards of a year to resolve itself and you may just find that over time the toes will hurt less and less, but I would recommend speaking to your surgeon and being pro-active.

Marc Mitnick DPM
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