osteonecrosis

by Kayla
(Abilene,TX USA)

I am 26 years old. I had an Austin bunionectomy performed two years ago. As a complication of my surgery I experienced avascular necrosis. In the past three months I have achieved a pain level higher than I had before the bunionectomy. I trust my surgeon and I understand these things happen. He wants to do an joint replacement. I don't sleep at night from the pain (even with 200 mg of celebrex daily and Lortab 7.5 PRN). I am afraid to have the surgery to repair the joint that has visibly collapsed in some areas and is obviously arthritic. I was wondering if you had any information about the joint replacement. I am starting a nursing career in the OR and really need to be able to walk, and I am miserable, but there is not a lot of research on foot arthroplasty and I'm afraid. I would just like to know if you have any information on the joint replacement, or if you have had any experiences with this type of surgery. Thank you for your help.

Hi Kayla,
You are right; all surgery has risks and unfortunately you are experiencing a risk associated with osteotomies.
I would really need to see the x-ray, but before I would consent to an implant (the life expectancy of an implant in the first mpj is 10-15 years, so at your age you are looking at maybe 2-3 further surgeries down the road), I would talk to your doctor about a bone graft to replace the diseased bone and perhaps in conjunction with a bone stimulator.
Assuming you do not suffer from any metabolic disease, are not on long term cortisone or a heavy alcohol consumer, I think the bone graft and bone stimulator makes a lot more sense. I am basing all this on the probability that the articular cartilage of the first metatarsal head is intact.
Do not be afraid to get a second opinion.
Marc Mitnick DPM

still having pain walking 3 1/2 months after bunion surgery

by Joanne
(Lancaster, MA)

Had bunion surgery performed January 7, 2009. Bone was cut further up on foot and secured with a plate and 2 screws. In a huge cast for 2 weeks, and then a smaller cast for an additional 4 weeks. No showers, no weight bearing during this time. Cast removed and in a boot for another 2 weeks, after which I was allowed to put weight on my foot. It never felt right. Now, 3 1/2 months later the foot still swells, and it is very painful walking. Xrays show the bone is healing well, but I am still in constant pain. Can't even walk barefoot because there is now a bone on the bottom of my foot that hurts too much. Everything hurts, my foot, my ankle, my leg up to my hip. Do I just need to give it more time? This is very discouraging!!!!!!

Hi Joanne,
By 3 1/2 months the bone that was broken should be healed. If it is not, there may be an issue. Speak frankly to your doctor about your pain. If he or she feels that your postoperative schedule is what it should be, ask if you can go for physical therapy. Physical therapy is wonderful for moving the healing process along.
Marc Mitnick DPM

Still pain in ankle one year after surgery

by Cassie

I had surgery on my ankle over a year ago and it still bothers me. Something is also clicking in my foot. It hurts at times and is stiff at times as well. My knee also bothers me especially when I am standing or kneeling for some time. I injured iwhen I accidently kicked a ball over a fence and then climbed the 5 foot fence (a little over my height), and then twisted my body around to avoid my neighbor's garden and landed awkwardly in a hole. I fell and heard a huge pop. My ankle never healed as I had fractured it, also torn ligaments and damaged one of my tendons. This is why I needed surgery because it never healed properly. But it stil bothers me over one year after surgery. Could my knee may have been injured also from that twisting I did? Do you think there is still something wrong in my ankle after that surgery?

Any advice will be greatly appreciated. Thank you.

Hi Cassie,
One would think the ankle would be feeling better, if not completely, one year after surgery. I obviously cannot help you but you should return to your surgeon, and let he or she know that you are still in pain. I would think an MRI would be indicated at this juncture. Physical therapy might also be helpful but it probably would have been more helpful right after surgery.
The knee pain may be a result of your fall or it may be the result of an abnormal gait due to your ankle pain. If it started way after the surgery then it is from your abnormal gait; if it was present right after your fall, then it was the result of the fall.
Check in with your doctor and le he or she know what is going on.
Marc Mitnick DPM

Question about bunionette surgery outcome

by Jane
(Maine)

Dear Doctor,
I'll try to be brief. In May of 2008 I had bunion and bunionette surgery on my right foot, osteotomies and temporary pins for both metarsals. I was healing well and discharged from Podiatrist at seven wks post-op. At approximately 10 wks post-op I went to my PCP because of a suspected bone spur on 1st metatarsal. My doctor took x-rays, and was quite upset because the fifth metatarsal was broken. I had no swelling or unusual pain, just minor discomfort. My podiatrist reviewed the new x-rays and said not to be alarmed, that the bone was healing as he wanted it to. He said the new tissue growth between the bone would act like a joint. Does this make any sense to you? My PCP seemed incredulous, but he referred me to the POD and felt he was a good doctor. He has been performing surgery for 30 years. I doing well now, taking aerobics etc. I have minor pain on fifth metatarsal side.
Should I return to POD? Is this purposeful non-union outcome legitimate, or do I have a real problem on my hands? What are the implications for arthritis in my future. Thank you very much for your feedback.

Hi Jane,
It sounds like you have what is known as a fibrous union which is not a complete bone to bone healing of the osteotomy site. It is called a false joint for that reason, meaning there will be some motion in that area (which should have no motion).
Having said that, many times people end up with a fibrous union for whatever reason, but truthfully if there is no pain (and you state you are doing aerobics) then you may be fine with it.
Of course since the union is not as strong as a bone to bone union there is always the possibility that it will re-fracture.
Why not suggest to your doctor the possibility of using a bone stimulator. This is a device that attempts to further "knit" the bones together.
I have used it a number of times on fractures and in many people it can be quite useful.
Good luck.
Marc Mitnick DPM

Foot pain from hammer toe & bunion with tight rope I think

OnFeb 6th 2008 I let a Board Cert. Dr. Operate on my rt. foot for Bumion & Hammertoe Problems . My original problem was big toe rubbing agsinst second toe causing pain. The big toe was way out of line causing the rub and second toe being a hammertoe. Well after all of this my foot is awful. The second toe was pulled down and now the big toe is completely over the top of the second toe. I'ts awful and really hurts at night. Cant even let my bed covers touch the toe. I'm much worse off now than before surgury I think the Dr. used the tight rope. What can I do now? The previous operation was ths worst thing I ever endured and I'm not sure I can't
go through that again. Is there any non invasive corrections out there?Ross McMillan

Hi Ross,
It is unfortunate that your foot ended up the way it did. I hope your doctor discussed the possibility of surgical failure with you prior to the procedure as that is one of the risks of undergoing any type of surgery.
You might want to try a bunion splint which attempts to hold the toe in a more straight alignment. It is certainly not a cure but it may improve the alignment of the big toe. Go my section on bunions and you will see the device. It is not terribly expensive and may give you a lot of relief.
Marc Mitnick DPM

numbness and foot being purple after surgery

by susan
(coventry)

its been 2 weeks since surgery i have a rod in my left leg when i stand up for more than 5 mins it goes numb and turns purple right above my ankle why?

Hi Susan,

The purple discoloration is due to blood pooling in your ankle due to poor blood return. This is a situation that needs to be brought to the attention of your surgeon.
Marc Mitnick DPM

Planter release surgery complication

by Sherry
(Scranton/Wilkes-Barre, Pa)

I had planter release surgery 11 months ago and since then I have had pain on the lateral side of my foot. I have been trying to work with my doctor but he keeps insisting I have tarpel tunnel. I have had more cortisone injections and they are not helping. He refuses to treat me for anything else. I have done some internet research and I don't belive I have tarpel tunnel. I have no numbness, tingling or burning. I have terrible aching like a toothache. I was hoping you could reccomend someone in my area that would treat lateral column syndrome. Preferably someone who could manipulate the cuboid. I believe this is what I have.

Hi Sherry,
I think you are on the right track with lateral column syndrome, but not necessarily cuboid syndrome.
You just don't develop tarsal tunnel overnight. Unfortunately, I do not know any podiatrist in your area, but I would get as far away as possible from the person you were going to. You definitely need a second opinion. Call your local hospital for a referral.
Marc Mitnick DPM

small lump on the top of my foot where i had a bunionectomy

I had bunion surgery in 2002 and now I notice a small lump on the top of my foot where I was cut. I noticed it about a week ago. It is not painful,but I am very active, and run a least 3 times and week and do aerobics 2 times a week and I wanted to know if I need to get it checked out by a Dr. before it gets worse. Thanks for your help.

Hi,
I do not know if it will get worse or not, but if it concerns you then make an appointment with a footspecialist.
If it feels very hard, it may be a bone spur; if it feels somewhat spongy then it may be a soft tissue cyst.
Marc Mitnick DPM

pain still after almost a year with bunion surgery

by sabrina
(kyle,tx)

I had bunion surgery June 2008...went to all the follow ups and had no problem other than my toe being a little stiff, I got released after 6-8 weeks and started to feel about 2 month later that it felt like I was walking on a golf ball or had a rock under my foot the whole time, so I went back to the foot doctor and he took xrays and saw that the screws were irritating my foot..so in december 2008 I had surgery again to take out the screws and for them to scrape something, here it is May 2009 and I'm still in pain except now it's my big toe but not where the bunion was, it hurts and has pain on my big toe itself on the side next to the other toe (dont know if that makes sense) and all the way to the top of my foot and now I dont know if I should go back to the doctor or what...I went to have the surgery cause I would have red irritation and pain on the side of my foot but could walk,jump,crouch etc...and now it is painful to walk with or without shoes...please help if you can..I dont know what to do...thanks in advance

Hi Kyle,
Well....I think you owe it to your surgeon to at least get his opinion as to what is wrong since he is the most familiar with your problem.
Before you let him doing anything invasive (if he suggests that) I would then go for a second opinion.
Just remember, further surgery does not always remedy problems created from the first surgery.
Marc Mitnick DPM

Recovery after tailor's bunion / bunionette

by Alexandra

I had a surgery 17 days ago for tailor's bunion. They took away a bit of the bone, did something with the bursa and tightened up the joint in some way. I have pain in the foot if I try to stand on it (at all). I can't move the toe unless I put my finger on it to bend it... Is this normal? The doctor didn't give my any advise on what to do after the surgery, I held the foot up high the first day and I haven't been able to walk on it at all because it hurt inside the foot and the bandage was so big. How do I best train my foot? I want to be able to walk soon and I don't want to get stiff.

Hi Alexandra,
17 days after surgery you may still be experiencing some pain but at this point you should have certainly seen some reduction of pain. Tell your doctor that part of his or her job is to give you guidance on what to do after surgery; that's what they get paid for.
Assuming you did not have any type of osteotomy (the surgical breaking and resetting of bone) you are probably a candidate for physical therapy at this point. The therapy should go a long way in reducing your pain, but this is a decision your doctor has to make.
Marc Mitnick DPM

re-injury to post-op foot surgery

by Beth
(Maine)

Several months ago, I had foot surgery to repair a chronic fracture of third metatarsal (have been on prednisone for 8 years). Doc harvested bone from tibia, screwed into the area where they had cut away the damaged bone.

Have been following all directions, just recently started full weight-bearing. Saw hardware at visit last week, all very happy with the stability, etc.

Yesterday I was walking around more than I should have been (getting family ready for a weekend away). At one point, I stood up, and on maybe my second step on that foot, I heard a popping noise. Sort of like the sound you hear when you close a snap. More than 12 hours (and a night's sleep ) later, I am still unable to put any weight on it. Even at rest and elevated, I feel a vurning sensation around the fusion site. Toes a bit swollen.

So for the weekend, I'm out of state, and if it stays the same, was going to maake arrangements for an x-ray. The idea that I might somehow have dislodged something...or cracked one of my other fragile bones, is making me crazy.

I am 46. Do you have any thoughts about possible dx and/or immediate treatment? Thank you.

Hi Beth,
It needs to be x-rayed because as you imply the first thought would be that you re-fractured the bone.
I would make an appointment with your surgeon as soon as possible.
Marc Mitnick DPM

purple foot after bunion surg

by donna brooks
( eddystone pa 19022)

had foot surg-bunionectomy-pins/screw did bump big toe bad and got hematoma took levaquin still purple and swelling as soon as i stand surg on may 4th also big toe doesnt toucg floog maybe due to swelling-ball-at area just under big toe.scared i cont. to elevate and ice as much as poss.feel like string wrapped around big toe when standing and being pulled -help

Hi Donna,
The discoloration does not concern me as much as the fact that the toe does not touch the floor. Normal color "should" return over time, but not having the big toe purchase the ground may be a problem for you after you are healed.
I think you should speak to your surgeon and let he or she know whats going on and then your surgeon can determine if it is an issue or not.
Marc Mitnick DPM

Burning and aching pain - ankle fusion 20+ years ago

by Kelly
(Canada)

20+ years ago I had an accident that crushed my ankle & foot, tore the anterior cruciate ligament and severed my achillies tendon.

2 plates and 16 screws were used to reconstruct my foot and fuse the ankle. Surgery to the anterior cruciate ligament has been attempted twice. Recently I have been given a clinical diagnosis of HMSN.

Over the years I have had mild to moderate pain in that ankle. In the last couple of years the pain has been increasing. Now walking for a few minutes causes severe burning pain in the ankle, top of foot and toes and it is beginning to travel up the leg to the knee. Some days just putting pressure on the foot causes horrible pain. Most of the pain subsides as soon as I take the weight off that foot. Over the counter medication no longer alleviates the pain.

Is this type of pain typical many years after this type of injury? Or is my HMSN aggravating my situation?

Hi Kelly,

Any time you fuse a joint, especially an ankle joint, two things occur. One, it changes your gait forcing excessive strain on the muscles of the leg as well as stress on the knee and hip joints. Secondly, a fusion also puts excessive pressure on the foot joints, so after 20 years it is not surprising that you are developing these pains. You really need to be worked up by a doctor to seem if with shoes modification some of the stress of walking can be alleviated.
Marc Mitnick DPM

morten's neroma after bunionectomy?

by sheila
(san jose, ca. USA)

I have been in horrible pain ever since day one after my bunionectomy. I thought it was the screw that was put in but it was removed and still the pain persisted. Then we did a round of cortisone shots..nothing helped...now it seems orthotics is recommended. An MRI showed maybe something with morten's but I am not sure what to do AND my biggest concern is...did the bunionectomy cause the morten's due to something that happend during that surgery???? hellllllp! the pain is a 10! sheila Is it POSSIBLE the doctor did something wrong? I know doctor's tend to protect each other but I'd really like to know why this is happening! Thanks!

Hi Sheila,
From three thousand miles away it would be difficult to determine whether your doctor did anything wrong but certainly a second opinion by another doctor in your area might prove to be helpful.
A true Morton's neuroma occurs between the third and fourth metatarsal bone and if that is your diagnosis than I would say the surgery had nothing to do with it, but perhaps if you were in a cast or surgical shoe, that might have aggravated it.
If your "neuroma" is in the area of the bunion surgery (and there can be nerve entrapments in that area), there is certainly the possibility that it is the result of the surgery. Is it the result of negligence? I cannot say. Poor dissection, poor closing of tissue, and the normal scar formation that occurs in surgery could all be culprits.
If you have a good working relationship with your doctor and he or she appears to be concerned about your problem then go with what they say. If you are skeptical about you are being told then as I suggested earlier, get a second opinion.
Marc Mitnick DPM

Rehab after surgery for plantar fibromastosis

by Robbie
(Monongahela, PA)

My son had surgery to remove a plantar fibromastosis on May 23, 2008. To date, July 9, 2008, he is still not able to fully walk on this. He is a high school football player and is extremely depressed. Are there any good rehab exercises or techniques which we can employ to try to get him back to practicing and running on this foot? I would appreciate any information available. Thank you in advance for considering this question.

Hi Robbie,
The problem with foot surgery unlike surgery elsewhere on the body is that you end up walking on the area that has been surgically repaired, which means foot surgery can take longer to heal than surgery on other parts of the body. The most important aspect of your son's surgery is to allow the incision to heal without scarring which is always a concern when an incision is made on the bottom of the foot.
Your surgeon would be the one who could best assess your son's progress and you should ask he or she frank questions, but certainly physical therapy would help move the healing process along quicker. There is also the possibility that your son will need an orthotic of some type to protect the bottom of the foot.
Marc Mitnick DPM

injury post op to hammer toe repair

by jules
(virginia)

I am 7 mnths out post op from a bunionectomy, hammer toe with tendon transfer. I dropped a heavy object on my 2nd toe that had originally had a pin to correct. I am now unable to wear a shoe and the pain is when i try to walk bending my foot to move forward. It didn't bruise or swell, but is painfull up over the top of my foot as well as in the base of the 2nd toe it'self. It's been 3wks and I'm still in pain.

Hi Jules,
The simple answer is you need to have an x-ray to make sure you did not break a bone. If the x-ray is normal then you evidently did some soft tissue damage in an area that was already tender from previous surgery.
You really need to see your surgeon.
Marc Mitnick DPM

increased pain resulting from a post op. bunionectomy shoes

by Laverne Webb
(Washington, DC)

I had a bunionectomy on December 18, 2008. I still have pain that comes and goes in my foot and some swelling. What bothers me most is trying to wear the second shoe I was given which is called a negative heel shoe or orthro wedge shoe. The first shoe I was given was light blue with a flat white sole and was ok, but the second black shoe which positions my heel lower than my toes when wearing it and has what looks like most of the sole underneath my toes are missing, cause lot of stress on my legs and also pain at the bend of my knee, on the back of my leg. I keep thinking that surely wearing the first flat shoe is best for me because it feels more comfortable. Can you tell me if I should wear the shoe that is most comfortable?

Hi Laverne,
Actually I look at surgical shoes as a necessary evil. I generally prescribe the flat one but invariably patients will come back to the office complaining of back pain.
Why did your surgeon switch shoes, were you having a lot of pain in the bunion area? Generally the second type of shoe that was dispensed to you is designed to take pressure off of your forefoot. It appears however, that it is causing you pain elsewhere.
Speak to your surgeon about your problem, you should be able to arrive at some happy compromise.
Marc Mitnick DPM

poor circulation in foot after ankle surgery

My niece had a cysts removed from her leg in the ankle area. they packed the area with cadaver bone. it is now week 7 after surgery and she still has poor circulation in her foot and must elevate it for blood to circulate normally. When should the circulation return to normal ?

thank you

Hi,
Without knowing much detail it is impossible for me to offer a time frame. If there is any concern then your niece should speak to her surgeon and make sure everything is fine.
Marc Mitnick DPM

Burning pain after foot surgery

by D
(RI)

I just got surgery yesterday on my metatarsal bone. I had fractured it and the doctor put a plate held in with four screws in my foot. Yesterday I was fine because of all the meds but today I feel an intense burning pain. How do I know that it's not infected under the cast?

Thanks!
D

Hi,
It usually takes a minimum of 36 hours after surgery for an infection to take place, so I doubt it is infected, but since you are having a pain that is not expected I would suggest you call your surgeon and let them know and see what he or she has to say.
Marc Mitnick DPM

pain and swelling 5 months after triple arthrodesis

Good morning,
Had triple arthrodesis on 10/31/08. Problem was moderate arthritis, and severe club foot deformity. I truly believe i needed the surgery, am just not too happy with the way i am feeling. I was doing pretty well up till about a month ago, but now i have almost disabling pain in my shin, swelling in foot, ankle and shin. The heel is painful to walk and to even touch. Everytime i talk to my doctor's assistant, she says "it's normal". I may beleive that, but was doing pretty well until recently. What do you think this could be, or is it normal?

Thank you,

Hi,
In general terms, patient's post operative pain diminishes as time goes forward, so when one of my patients tells me that the pain is worsening I usually become somewhat concerned.
Your problems may only be activity related, in other words since you were starting to feel better you may have become more active and the inherent problem here is that you have a fused foot which puts tremendous pressure on the adjacent joints that are not fused, in this case primarily the ankle joint. Additionally the tendons in your lower leg may tire more quickly and become irritated, the combination of which may be causing the pain and swelling.
Let your doctor know what kind of activity you are doing, perhaps it is too much for your situation. A round of physical therapy may also be quite helpful.
Marc Mitnick DPM

I broke my ankle more than a year ago but it is still swollen. is that normal?

by marissa
(normal, il., u.s)

i broke my ankle on may 6th 2008. the bottom part of the ankle bone came off. the doctors said as long as i didnt have any pain that it was fine. i started getting pain like not that often but i do on ocasion. it was swollen the first day like the size of a softball,literally. it is still swollen but it isnt that big but it has been longer than a year so i was just wondering if that was normal or if i should get it checked out.thanks

Hi Marissa,
Assuming you have pins and a plate in your ankle these areas can stay swollen indefinately, although they will be less swollen over time.
The real issue is how much the ankle hurts. If you have pain that prevents you from doing the things you want to do then you should revisit your doctor; if it is more occasional discomfort that does not last long periods of time, you will probably have to live with it.
Marc Mitnick DPM

searing pain over surgical incision

by Cathy Jorgenson
(Eagle Mt, UT)

In October 2007, I had a bone spur removed from the right first metatarsal joint by a podiatrist. He said he felt the bone spur was formed because my metatarsal was too long, so he did a wedge into the top of the bone and anchored my great toe down with a screw. It seemed to heal up well except that a tendon kept getting caught on the screw and it was like constantly bumping my "funny bone" - numbness, tingling, parasthesias. So four months later, he went in and removed the screw. This is now July 2008 and I continue to not only have frequent searing hot pain at the site but I have a bump as big as the original bone spur. None of my shoes from before the surgery fit and it is just as difficult to find new one to fit.

My question is should I go back to the same podiatrist or get a second opinion from another podiatrist or orthopedic surgeon who specializes in the foot and ankle?

Hi Cathy,
The first person you should consult with is your original surgeon, give he or she an opportunity to explain why there is still a problem and offer a solution. The reason I say this is because this surgeon is most familiar with the way your foot looked prior to the first surgery.
After that I would then consult with another surgeon (either a podiatrist or foot oriented orthopedist), to get a different slant on what needs to be done, if anything.
Unfortunately the final solution may require more surgery so you want to make sure you make the "right" decision before consenting to any more procedures.
Good luck.
Marc Mitnick DPM

failed fusion of great toe

had fusion first of Dec with plates and screws. Several wks later, infection
present. Antibiotics for several wks. no outward drainage-toe just extremely
red. As of April- toe still swelling and red with some fusion showing. Had surgery
last of April to remove hardware ,cultures taken and k-wires inserted. Bacteria
was Staph Epi. Two more wks of antibiotics and toe looked much better. K-wires
removed after four wks. to md today. toe looks better but still no complete fusion' gaps in fusion. Still have pain when step off curb, go down steps or after about
30mins of walking. Can not walk bearfoot as pain occurs. MD not quite sure what
to do now- states there are other surgeries-graft, or injections with stem cell, or bone stimulator. Any suggestions.

Hi,
Before you consider anything invasive you could try a bone stimulator; they can work quite well, it would just depend on the size of the gap between the two bones.
If that does not work, then unfortunately you are looking at additional surgery, either another fusion with a bone graft or even an implant. Since you have a history of infection I would be concerned about an implant because if another infection were to occur, the implant would have to be removed and that could leave you worse off then you are now.
There is no simple answer here, but I think the bone stimulator might be worth a try; there really is no downside to trying it.
Marc Mitnick DPM

Increase in pain after bunionectomy

by Lois
(Georgia)

I'm 4 months post op from a bunionectomy. In the last week I have noticed an increase in my pain instead of a decrease. I had been doing pretty well, I thought, but now I don't know. I now have return sharp pain in the bunion area (that had gone once I had the surgery), sharp and burning pain in the same joint but on top instead of the side, and burning pain where the bone had been broken to realign the toe. Is this normal? I have not done anything different in my daily routine nor have I increased exercise...in fact, I have decreased activity due to this onset of pain. The pain now is more constant than I had even prior to the surgery...before it was just random throbbing every couple of days, now it is all day long every day.

Lois,
It is not out of the realm of possibility to have a temporary set back during the healing process, four months is not that far along.
The proper move here would be to have a discussion with your surgeon. Obviously he/she will be able to examine the foot, I cannot, and see if there is anything to be concerned about.
You may want to wait another week to see if the symptoms quiet down on their own, but if they persist, have the foot looked at.
Marc Mitnick DPM

tightrope procedure after 12 weeks still very painful and swollen

I had multiple procedures done on both feet on Jan 7, 2009. Post surgery, I felt as if the top of the foot was wrapped in a tight rubber band. as the weeks went on and the top of the foot became more and more painful, I ask the surgeon if I could be having a reaction to the tightrope or surgical wire. The company came back with that maybe I was alergic to the nickel in the wire.

I am in a great deal of pain and my foot is getting very stiff. Now he says I may have to remove the tightrope. They are on both feet although my right foot is far worse than left. I still cannot walk or stand for long periods and have a great deal of throbbing pain and swelling.

I dont know what I should do. I am afraid of surgery again fearing I may be worse off than ever. Please let me know if other patients have experienced same results and what should I do about it.

Hi,
I have not come across similar complaints but as I stated in my section on bunions, the tight rope procedure is a new procedure and therefore there are things that could go wrong that has not been previously accounted for.
You could go to an allergist to see if you are allergic to nickel, but perhaps the bigger issue is that after all these weeks you seem to be getting worse.
Taking out the wire should not be nearly as time consuming as putting it in and so the recovery should not be nearly as bad.
What you will be left with is a foot that looks pretty similar to the way it looked before surgery unless the surgeon discusses with you doing an osteotomy (surgical breaking of bone) in an effort to straighten out the bunion. You of course would have to decide whether or not you want to go through all that.
If you are in as much pain as you state then I do not think you have any choice. Read my section on "surgical consideration" and you will see the risk/reward ratio is definitely in your favor at this point.
Good luck.
Marc Mitnick DPM

Ankle Surgery

by Hannah
(Ireland)

I am having ankle surgery on 19th of feb to remove pins and plates. Broke my ankle 6 years and got my k wires removed 3 months after my first surgery. i just want to know is it going to be a very long surgery and how long will my recouperation be.

Thanking you

Hannah

Hi Hannah,
Since I know nothing about you, age, weight, degree of ankle fracture, etc. I cannot tell you how long your recuperation will be. But, suffice it to say, removing hardware is much less involved than putting it in, so your recuperation will be shorter than the original surgery.
Marc Mitnick DPM

weight bearing pain after ankle fusion

by steve
(Orlando Fl.)

I was involved in an auto accident on 2/09/2009
three surgeries, the fix was. s/p right ankle I&D with fixation of right distal tibula, fibula fx.

the question is. i am using an aircast with a walker and trying to do weight bearing excercises, the pain is on the ball of the foot and the top, also near the pinky. And there is also pain near the joint of the ankle, it's seems i cant bend it because of the screw. that is what is stopping me from using the full weight on the foot is this normal? the swelling is still there of course.
it is now 5/16/2009..

thanks, Steve

Hi Steve,
You really need to speak to your surgeon about this. For the pain on the ball of the foot there is probably some kind of padding that can be added to the Air Cast to take pressure off of spot, but if one of the screws is bothering your foot, you will have to wait until the fracture is healed and more than likely the screw will have to be removed. Your surgeon would be best suited to give you a time-line as to when that will happen.
Marc Mitnick DPM

stabbing pain post bunionectomy

by Anne
(Canada)

I had a bunionectomy on April 6, 2009.
On April 24th, 2009 I had X-rays taken and another cast put on. Only in the last week (in the 5th week after surgery) I have started getting sharp pains under and on top of my foot. I have a check up appt on Friday May 15th for X-rays & change cast... Should I be concerned about the sharp pains and see the Dr. sooner or wait until next week??

Thank you.

Hi Anne,
In general terms the amount of pain a patient experiences should diminish as time passes. If all of a sudden there is an increase in pain that may be a signal that there is a problem.
My best advice would be to call your surgeon's office and tell them about your pain, let them question you about it and if they are concerned about it I am sure they will have you come in sooner.
Marc Mitnick DPM

6 mos post op arthroscopy and still having pain

by Tired of hurting
(Hobart, Indiana)

I am a 30 year old female. I am diabetic. About 5 years ago my right foot started hurting really bad to the point where I couldn't tolerate even standing on it, let alone walking. I am a nurse aide and I am on my feet all the time. I went to several doctors who just told me that I had degenerative arthritis and sent me on my merry way. I was referred to a podiatrist last year who gave me the same diagnosis. He gave me cortizone shots in my right heel and ankle every 3 mos for about a year and finally he told me that I needed surgery and that was the only way they could correct the problem. He did an arthroscopy, nerve repair, and scraped some tissues in my heel and ankle. To make a long story short,it's been 6 mos now and I am having severe swelling and pain in my right foot and it's to the point where I can not fit any shoes because my foot is so swollen it just wont fit. I can only wear flip flops and they have to be 2 sizes too big. The doctor that did the surgery told me that it would be normal to swell for the next 6 mos to a year off and on, but I swell all the time. He said since I'm pregnant there is nothing he can do and just kind of left me out there. My left foot is normal and never swells at all so I know its not swelling from the baby, but I dont know what's causing it to swell. It is very painful and my toes are all swollen as well. The back of my foot where he did the surgery is not as bad, but it's the top part of it and my toes that are swelling the worse. My ankle just recently started swelling as well. What is causing this and what can I do about it?

Hi,
Foot surgery although rare can be painful six months down the road, BUT, the intensity of the pain should be lessening on lets say a week to week basis. It sounds like you are not experiencing this lessening of pain.
The fact that you are pregnant and the associated hormonal changes that are occurring may in part account for the delay in healing, but I am concerned about the amount of swelling you are still having.
It is difficult for me to make a diagnosis without actually examining you, but it does sound like your problems are out of proportion to what I would expect at six months.
Since there is a potential for a chronic problem I would suggest you seek another opinion from someone in your area familiar with the type of procedure you had done. In general terms, the nice thing about arthroscopy versus open surgery is that there is less trauma to the area so the recuperative period should be quicker. This does not sound like your situation. You need to find out why.
Marc Mitnick DPM

After a fusion and leg fracture 8 months ago, I am still walking but have pain. Is this normal?

by Julena Stewart
(Riverside, CA)

I had a fusion in my right ankle. Prior to that I had a failed surgery on the same ankle. The screws backed out and I fractured the leg. I am having pain still after 8 months. I had custom orthotics made and it is better, but the pain is still there. Is this normal?

I have special rocker shoes and the custom orthotics help me to walk normally. If I take the shoes off for 1/2 hour the pain is strong and I can't walk well. I drag my leg. Is this normal? What type of physical therapy is used.

Hi Julena,
The rocker bottom shoes try of make up for the lack of motion in your ankle due to the fusion. I would imagine that without the shoes you would have difficulty in walking.
You can try physical therapy, but I think it comes down to this: You need the rocker motion of the shoes in order to get from point A to point B. Without them you are always going to have some degree of pain whenever you try to do a lot of walking.
Marc Mitnick DPM

PAIN AFTER FOOT FUSION

by Bonnie
(Indianapolis)

Greetings I have had a foot fusion and then a revision and then
had to have 2 screws took out because they were backing out.
Now I have found out that one of the fusions has not took. The
Dr said to see if it was heading in the right path rather than
to do another surgery. HOw long should I let this be the plan?
How long may it be before the fusion takes? Please help me I am
at my wits end with pain!!! Bonnie in Indianapolis

Hi Bonnie,
All things being equal, the doctor should know within six to eight weeks whether or not the fusion will hold even with the screws missing. Let your doctor know you are in pain, things can be done.
Marc Mitnick DPM

red/purple painful foot/post surgery

by jeanne
(loomis, ca)

Had decmopression of neuroma 3 months ago--2 months ago foot started burning really bad, also turns reddish purple in the shower or when hanging down sitting or standing. I have no other symptoms of RSD, so dr is unsure of whether I have it or not..still have the neuroma pain when I walk, but the burning pain lets up a little when I walk? Would love your opinion.

Hi Jeanne,
Is the whole foot discolored or just the area around the surgical site? If the whole foot is discolored and an ankle tourniquet was used during surgery I would look towards some vein damage from the tourniquet. If the surgical site is just turning color then that would be from the surgery and damage to the local veins which should subside over time.
If you are still getting burning in the area, even though, the burning is less than prior to surgery, my first thought would be a stump neuroma (see my article on Morton's neuroma). This is a common problem with neuroma surgery.
If your doctor determines it is a stump neuroma, I would recommend denatured alcohol injections; they can be quite helpful in these situations.
Marc Mitnick DPM

hematobe recovery

by Leroy
(London)

I was kicked in the back of my right leg on the centre of the calf muscle whilst playing football 3 months ago. A pea sized lump appeared with no signs of external bruising . I was told by my gp this was a hematoba . The problem is that the lump is still slightly there and i experience pain at the point . As a cyclist i am finding this painful after cycling . Should I not be cycling and is there anything else that can aid recovery or is this a pain that won't go away?

Hi Leroy,
A hematoma should have resolved itself after three months. It is possible you have a superficial phlebitis and that would require medical care. Go back and see your doctor.
Marc Mitnick DPM

Recovering from Instep plantar fascitomy

by Melody
(Las Vegas, NV)

I had this surgery July 30,2008 on my right foot. Today is Nov 10,2008. I do have some scar tissue which is why I am taking Neprinol(systemic enzymes) which are working for me. But I still have sensitivity and pain. Its not the same pain as I had before th surgery. Its more like a soreness and my foot feels weak. I take plenty of vitamins though along with extra Vit c. Also sometimes I have a fast shooting pain,kinda like a tingly shooting pain. Usually it just happens once a day if and sometimes I don't even have it everyday. I just wanted to know if these feeling of weakness and tingly shooting pains are normal. If this is normal and part of recovery, how long will this last usually? I know everyone is different but what is the norm. If this is not normal, I will have to go back to the doctor. Could you email me back please at Thank you

Hi Melody,
Since I cannot examine you and do not know what type of fasciotomy you had I can only "guess" at a few things.
The type of symptoms you are describing seem normal for correction of your type of problem. My rule of thumb to my patients is that as long as you see an ongoing reduction in symptoms on a week by week basis, then you are doing fine. If you reach a point where the symptoms have seemed to stagnate and there is no further improvement then that is a reason for concern.
Remember, your surgeon is responsible to you even after the surgery. If you do not think you are progressing in the manner expected then you need to bring it up to he or she.
Marc Mitnick DPM