Tingling 9 years post-arthrodesis

by Katie
(Fort Worth, TX)

Hello,

In 2002 I experienced a Lisfranc fracture-dislocation to my 1st metatarsal, left side. Three surgeries were performed:
October 2002- ORIF with 1 pin; 1st metatarsal- cuneiform joint develops trauma induced arthritis
April 2003- fusion with 1 screw: This fusion resulted in a non-union, despite months of using bone stimulator.
February 2005- revision of fusion including bone graft from Left heel, nerve block, and 2 screws used. Recovery time was doubled from the usual and PT attended after that. This surgery successfully fused. I was a gymnast and worked through a lot of pain to recover.

Fast forward 9 years...
Recently I have been experiencing shooting pains, numbness, and tingling originating from the surgery site and traveling toward my toes. There is also slight swelling in the area. X-rays from general practitioner show all hardware is still in place. Ice, epsom salt, NSAIDS, arnica, taping of the arch have all been no help.

Background:
Female, 29 years old. Athletic coach, so basically on my feet all day in athletic shoes with arch supports in them. I was working out 6 days/week until about 6 months ago. By not working out I have gained about 10 pounds in those 6 months (5'4" went from 150-160 lbs).


Is this just a part of having a fusion and severely traumatizing my foot? Should I just expect pain to pop up every now and then for the rest of my life? I cannot think of anything I have done to re-injure the area. What should I do next?

RESPONSE

Hi Katie,

I guess I could just answer yes and say that your pain in the post surgical site is normal and you have to live with it, BUT, how do you know this pain is going to go away, or even get worse?

You had a lot of surgery in multiple stages in one small area of your foot and after the third try everything seemed to work out. The problem here is that despite the best efforts of your doctors including hardware and bone grafts, the fixation has inherent weakness in it.

You essentially had a fusion of a joint, a joint that generally has some movement in it. The first metatarsal bone in most people has some up and down motion which occurs at the metatarsal-cuneiform joint. In your case the joint is now fused, so you are constantly stressing a joint that is now fused.

This problem is only worsened by the fact that you happen to be very athletic and even with sneakers and orthotics you still put a lot of stress on a joint that is fused.

So, it would not be surprising to me at least, for you to be complaining about the pain you are experiencing. Yes, you are right, that with some rest, taping, and medication the problem may calm down, and you certainly could try that, but my thought is that a bone scan or even an MRI might be more telling as to what is going on.

Although the hardware appears in place on your x-ray it does not mean that there has not been some small motion or that there is a new "crack" in the fused bone. These small changes are not always visible on x-ray.

What you might consider doing short term, would be to go non-weightbearing on the foot with the use of crutches for a few weeks to see if the pain will go away. Perhaps three to four weeks. Assuming after that period of time, the foot feels a lot better, then you could consider resuming your activity and see what happens. If there is no pain, great, but if the pain returns fairly quickly (or never actually goes away) then I would suggest further testing such as I have already mentioned.

You may end up finding that being an athletic coach is something that is going to be difficult going forward because your foot is not able to withstand the demands placed upon it.

Marc Mitnick DPM
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