Scarf&Akin Osteotomy- problem

by Lisa
(Arizona)

Hello, I've had my left foot already done as a scarf&akin osteotomy in Nov. of 2013 . Went well but I developed, a bloodclot ( DVT ) throughout entire leg...which explained the extreme delay of healing, extreme swelling , etc.

Now, I had my right foot done- same surgeon, as he is incredibly great.. one of best in State. I had proceedure 6•24•14. I was so happy as this surgery's recovery was so much easier. Well , I made some bad decisions- walked on foot w/o surgical boot around the house...that was just going into 2nd week. It hurt a bit, but I was dumb.
Problem is, I took a nasty fall. I also fell twice with the surgical boot on- even with it in, my ankle rolls & I stumble. It hurts badly all along the long metatarsal bone where the 2screws are(staple is up further -toe) I now live in the boot. Sleep in it too. I'm in 3rd week now & I'm wondering if I did damage that still fragile probably fragile bone, fixation. If I did, what would happen ? Would I have to go through another surgery? It literally hurts to touch that whole area. And there's a tiny lump on top of foot - right along that metatarsal bone & when I walk(back on crutches too) I feel&hear an "errr,errr" type thing& can feel it shift/click. I'm scared ... Feel stupid . Worried I've done damage. Any advise? I called my surgeons office today. Left msg. About situation but no rtn. Call.

RESPONSE

Hi Lisa,

The short answer to your question is yes, you need to contact your surgeon immediately. I have no idea if you upset the osteotomy particularly the Scarf procedure but from your description there is a good chance that you did damage and if so It will need to be corrected.

Even with adequate fixation such as screws or any other fixation device, a two week old osteotomy is still "raw" meaning the surgically fractured bone has not healed enough to withstand any stress placed against it. Many surgeons will have their patient non-weightbearing during the first few weeks out of fear of damaging the osteotomy site. Your surgeon chose to allow you to bear weight as long as you had the boot on, which also falls within the realm of standard protocol for this type of procedure.

The problem is you chose to walk around without the boot and of course on top of that you have fallen a couple of times even with the boot on.

The shift/click that you are feeling may be due to one of two things. The first may be due to a screw that has loosened and is now moving up and down as you walk. The second possibility is that you did damage to the whole osteotomy site and the two bones are actually moving when you walk.

Neither situation is good for the simple reason that if the two bones are moving against each other, they will never heal. Worse than that, if there happens to be a separation between the two bones, that too will prevent healing.

If one or both screws are not seated properly and even if the bones did heal, they might not heal in a proper alignment and the displaced screw would be a potential source of continuing pain simply because the first metatarsal bone does not have much fat on top or the side of the bone and the screw would be irritated by shoe pressure.

Now, what has to be done to your foot will be predicated on the actual damage to the foot. In a best case scenario if everything looks good on x-ray, when you are non-weightbearing then your surgeon may just put you on crutches and not allow you to bear weight for a few weeks.

However, if a screw is displaced or if the osteotomy alignment is off then additional surgery may be required. In very rare cases manipulation of the bone, under anesthesia may be attempted in an effort to straighten things out. Call your doctor today!

Marc Mitnick DPM
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