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The response to the question below was authored by Marc Mitnick DPM

Severe pain in big toe joint where bone spur was removed 4 years ago!!!

by Lisa
(Hoover, AL)

I had a large bone spur removed from my right big toe, in 2007. Ever since I had the surgery my pain has progressively gotten worse. I cannot bend my toe very much at all. When I walk, I walk on the side of my foot because the toe won't bend. Also, after I wear heels, my toe is very painful and it feels like it 'gets stuck' in the pushed up position. I have to manually move my or back and forth with my hands. When doing this it's very painful and feels like a nerve is being pinched or something. It hurts even when I wear flip flops and hurts when it rains or is cold.

Do I need surgery again? What is wrong? Why didnt the first surgery work? It's getting worse so I know that something needs to be done.
Please help!

RESPONSE

Hi Lisa,

Remember that I have not actually examined you so I am just "guessing" here, but in most cases where the pain comes back almost from the day after surgery, it is usually because not enough bone was removed.
Not only does the bone spur have to be removed but some healthy bone must also be removed in an effort to give the big toe the ability to bend upwards.
Not removing enough healthy bone is the major pitfall of this type of procedure. In the grand scheme of things it is usually the big toe that jams into the metatarsal bone, over the years, that causes the spur to form in the first place. (I am assuming the spur was on the top of your foot as this is the most common spot). So, when just the spur is removed without any healthy bone, the toe still jams into the first metatarsal and the result is pain.
We generally look at a lateral x-ray (side view of the foot) to see the relationship of the big toe to the metatarsal bone. In most individuals the first metatarsal bone is actually raised slightly thus causing the jamming effect. These cases in particular require some healthy bone be removed from the first metatarsal.
If that is not the actual problem, then my next thought would be scar formation within the incision with a probable entrapment of the superficial nerve that passes through there. This is a less complicated situation because the incision can be excised and re-sutured together.
Obviously, the smart move would be to go back to your surgeon and discuss your situation with he or she.
If you get no satisfaction, then a second opinion by a doctor in your area would be indicated.

Marc Mitnick DPM
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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Jodi

location unknown

Severe pain in big toe joint where bone spur was removed 4 years ago!!!

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