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Extreme swelling and pain 7 months after foot surgery

by Sheri
(Regina, Sk, Canada)

My daughter had surgery on her foot for turf toe (repair of plantars plate) and for a hammer toe. She had her surgery on June 9th, 2011. She had a pin put in her toe for her hammer toe at the same time. Her toe became extremely infected 3 weeks after the pin was put in and when she took a step the pin came shooting out. For the surgery for the turf toe she remained in a cast that totally immobolized her foot for twelve weeks. The cast came off August 25, 2011. Since the cast has been off she has been in constant pain and her foot has always been swollen. Her foot seems to become more swollen as time goes on. We has seen several doctors and nobody seems to have any ideas as to why her foot is so swollen. She has been referred to many specialist but no of them want to take a look at her. We ice her foot daily but this does not change the amount of swelling in her foot. If she is walking a lot or on her feet a lot the swelling becomes so bad that she cannot get any shoes on at all. The more her foot swells the more pain she is in. It gets so bad that she can barely walk. My daughter is only 15 years old. She does also have a couple of clips in her toe holding the muscles together. Do you have any idea as to why after 7 months she is still in so much pain and why the swelling seems to be getting worse instead of better? Please let me know what you think as I do not know what to do anymore! Please any ideas would be greatly appreciated!

Thank you
Sheri

RESPONSE
Hi Sheri,

After six months one would expect that your daughter would be well on her way to recovery especially at such a young age.
Although I do not have the luxury of examining her foot, I am a bit surprised that she had hammertoe surgery on her second toe as she seems kind of young, but again if the hammertoe was very severe I suppose there could be some justification.
Turf toe refers to a tear in the plantar plate of the big toe, so I am assuming she had surgery both on her big toe and surgery on her second toe as well.
May I also assume her pain is coming from both sites?
If that is the case, a few things come to mind. The turf toe procedure may have over corrected her problem and now the plantar plate is too tight thereby causing pain when she attempts to bend her big toe upwards. Manually bend her big toe upwards and ask her if she is having any pain on the bottom of the big toe.
The second issue is the fact that she had a k-wire placed in her second toe and developed an infection. Does the foot appear hot and swollen? There is always a possibility that she still has an infection, particularly in the bone. I must say though, that if you have been to a few doctors, one of them would have picked that up.
Another remote possibility is that when the k-wire came out, the whole wire did not come out and there is still a broken k-wire in her foot, but again, I suppose someone has x-rayed the foot since then and of course a broken k-wire would show up on x-ray.
The best I can offer you is to suggest an MRI, if one has not been done since the surgery. The MRI would give you the best visualization of what is actually going on in the area that has been operated on. Your daughter is way too young to have to have this kind of ongoing problem.

Marc Mitnick DPM
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