revision of bunion hammer surgery osteoporosis

Hi Dr.

I had bunion surgery/hammer toe surgery on my second toe in August 2015..my second toe is now longer than my big toe and as a result my big toe is drifting inward; I also do not have full ground purchase on my big toe...I believe I now have arthritis in my big toe as it is often painful when I bend it...the most pain comes from the second toe being so long...I am unable to wear most shoes
After six weeks or so I was cleared to go back to my exercise routine; I am very active and exercise daily
I am scheduled for revision surgery in June...the way the Dr explained the reason why my surgery did not go right is that I did not heal properly...the Dr is going to shorten the second metatarsal as well as trying to straighten as much as possible the big toe (removing scar tissue, etc)

I recently was diagnosed with Osteoporosis (I am 58 yrs old) and put on Fosomax as well as Vitamin D and Calcium supplements..
do sometimes these things just "happen" where one patient for whatever reason does not heal properly when another one does? understanding now about my osteoporosis I am thinking I should have been non weight bearing for longer than 6 weeks....
I'll have been on Fosomax and the supplements for about 2 months by the time of my new surgery...approx how long does it take on average for these to impact one's bones?

Thank you very much!
Marjorie


RESPONSE

Hi Marjorie,

There are a few issues I would like to touch upon. First off, before you consent to additional surgery from your surgeon, get a second opinion from another surgeon in your area. Any time a surgical result turns out as poorly as yours did, part of the blame has to go to the surgeon.

I do not have the luxury of seeing x-rays or even knowing what type of procedure you had done, but I will tell you this: anyone who does foot surgery, knows the procedures which tend to shorten toes and when planning has to take that possibility into account. At the very least the surgeon should have told you one of your toes would be shorter after the procedure, or he or she should have planned a different procedure based on how your foot looked on pre-operative x-ray.

The next issue is the fact that the surgeon wants to shorten the second metatarsal bone. The way that is done is by removing a wedge of bone and then putting the two ends back together. Here is the "rub". In order for the two ends of the bone to heal, you have to have good "bone stock" meaning good density to the bones. You mention you have osteoporosis which is a decalcification of bone and depending how bad the osteoporosis is, your second metatarsal bone may not actually heal. Again I do not have the luxury of looking at x-rays.

Fosamax does not build bone, it just inhibits the bone cells (osteoclasts) that remove dead bone cells. So even though over time, the density of the bones will appear better, they are actually not stronger bone.

This is why you have to be careful in doing osteotomies (cutting and repositioning bone) in a poorly calcified bone. If the bone does not heal in spite of having hardware inserted, you will end up with what is known as a non-union and now you will also have pain in the second metatarsal.

I should also point out that it is technically possible to have some degree of osteoporosis and still have enough good bone to do an osteotomy.

Based on your narrative I am concerned about your situation, but in all fairness I do not know all the factors that went into the decision making process. I may be totally off the mark here, but if your "story" is the correct one, then I would highly recommend you get a second opinion just to make sure your surgeon is doing the right thing.

Marc Mitnick DPM
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