second toe pain

hello i had big toe fusion last august for bad arthritis.the surgery for that went well and that joint is now pain free. my problem is now i have pain in my second toe and swelling. my surgeon said my joint had gone dead and there was probably nothing he could do and did not know what caused it.do you have any idea what caused this and is there anything i can do? thanks

RESPONSE

Hi,

When you say you had your big toe fused, I am not quite sure if you mean the joint in the big toe or the joint that attaches the big toe to the first metatarsal bone. I am going to make the assumption it was the joint that attaches the big toe to the first metatarsal as that joint is usually more subjected to arthritis and the pain associated with arthritis.
In an ideal world, being able to examine your foot, observing your gait and seeing an x-ray of your foot would be very helpful; obviously none of that is going to happen.
Therefore I will base my comments on generalities in this situation.
When you have a joint fused what happens in many instances is that the surrounding joints are "stressed" meaning that since the fused joint no longer functions, there is additional stress placed on the working joints near the fused joint. This is not to say that you should not have had the joint fused, as the degree of pain you were experiencing prior to surgery should have been the driving force in deciding to have the fusion. By your own account, the surgery alleviated the pain and of course that is a good thing.
Again making assumptions, I assume the painful joint now in question is the joint that attaches the second toe to the metatarsal bone, which allows the toe to bend upwards and downwards, not one of the joints that make up the toe itself. This would make sense since if the big toe joint is fused, there is now additional stress on the second toe joint due to the way your foot functions when you walk.
In further understanding this situation it is important to also take a look at the architecture of your particular foot structure.
When the great toe joint is fused, it is done by removing the cartilage on the base of the toe and the cartilage on the head of the first metatarsal bone. The two ends of bone are then fused together. The problem that can occur here is that if your first metatarsal bone was relatively shorter than the second metatarsal to begin with, it now would be even shorter as a result of removing the cartilage from the metatarsal.
What this does is put more pressure on the second metatarsal phalangeal joint (second toe attached to metatarsal). This too could cause your second toe joint to become swollen and painful.
I am not exactly sure what your doctor does means by a "dead joint" other than perhaps a non-functioning joint.
In any event, all is not lost. Assuming my assumptions are correct, we can generally re-distribute pressure on the foot through the use of an orthotic, which is a device that fits into your shoe, being built up in certain areas of the orthotic to take pressure off the inflamed portion of the foot and allow you to walk in a more comfortable gait.
An orthotic is not a cure, just like prescription eyeglasses are not a cure for poor eyesight, but it is a relatively simple way to alleviate pain.
If your surgeon has pretty much washed his hands of your case, I would suggest you see a foot specialist in your area, one who is familiar with orthotic therapy and see if this is an option that would be of benefit to you.

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Marc Mitnick DPM
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