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Complications from hammertoe surgery

In June of 2013 I had a cheiloctomy on my big toe, and a hammer toe fixed on the

second toe. The bone was cut screwed and pinned. The bottom of my foot was very
painful when walking. After physical therapy, and acupuncture I still had pain. I then had a MSK ultrasound which showed the screw had moved 2 mm. I had the screw removed in December 2003. I asked about removing the pin, but the doctor said that had to stay, or my toe wouldn't stay straight. I am still having pain in the second toe. The toe doesn't purchase the ground, and I have been taping the toe. The doctor believes it is the tendon. I think it is the pin, as when walking and extending my toes I feel pain. My foot is also very uncomfortable in a shoe.
My theory is if the screw moved, perhaps the pin also moved, or the bone wasn't set
correctly. I am at my wits end, and don't know what to do next. Any advice you can give me would be greatly appreciated. Thank You!

RESPONSE

Hi,

Let me first start out by saying this is a hard one to offer an opinion on without actually seeing your toe and at least an x-ray.

I am a believer that sometimes less is more, meaning a lot of surgeries done on toes is a question of over kill. If I understand you correctly, you had a screw and a pin inserted into your second toe. That to me is too much hardware for such a small area. Again, I may be missing something because I cannot examine you.

So you had the screw removed, but that did not help much as your toe continues to hurt and fails to purchase the ground. You also mention you get pain when you extend the toe; that very well may be the pin which may have backed up a bit and is irritating the joint between the toe bone and the metatarsal bone.

The fact that the toe fails to purchase the ground may be due to a tight extensor tendon, or, it may be due to the pin. Again, I would have to see your foot.

This is not rocket science. If you are in as much pain as you say you are then something has to be done. The smart money would be on getting another opinion from a local foot specialist.

In general, just lengthening the tendon to get the toe to purchase the ground might not be enough to alleviate your pain, because it is the extension of the toe that is causing you pain. If the pin is determined to be part of the problem, then the pin should also be removed. This might necessitate then doing a conventional hammertoe surgery, and yes, your toe might not be quite as straight as it is now, but it will probably no longer hurt. Which option would you prefer, slightly bent with no pain, or straight with pain?

As a side note, in general I do not like fusing toes, especially the second toe. If the second toe is now longer than your big toe there is a very good chance you will end up with a corn at the end of the second toe over time, simply because there is no "give" to the toe and it just jams into the end of your shoe.

As a final thought, it should be easy enough for the doctor to determine if the pin is causing your pain. He can look at your x-ray, note where the pin is located and then palpate your toe in the same area. If there is pain there, then there is a good chance the pin is part of the problem.

Do yourself a favor and get a second opinion.

Marc Mitnick DPM
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