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I have a hard bump behind the joint of my big toe

by Melissa
(Coram, NY)

About 15 years ago I had surgery on the toes on my left food because of a bunion. I haven't been able to bend my big toe since, but I can move it by hand and when I do it makes a clicking noise like it needs to crack, but it won't.

Over the past few months I started getting a really bad pain behind (bottom of the foot) the big toe, and eventually realized there is a hard bump underneath the joint. It's not skin, it feels more like it could be bone? It sometimes gets worse depending on the kind of shoes that I wear. I'm going to a podiatrist in a few weeks, but I was just wondering your opinion on what it could be (I'm having a hard time researching) and possible solution? I'm a little worried about needing surgery again!

RESPONSE

Hi Melissa,

In general, people do not get bone spurs on the bottom of the big toe joint as it is much more common on top of the joint.
Because you have had surgery on the bunion joint, anything is possible. I would like to know what kind of bunion procedure you had. In general in a simple bunionectomy there is no "work" done on the bottom of the bone so the chances of the surgery having caused this bony prominence, even 15 years later is not likely.
In the more involved bunion procedures where the first metatarsal bone is surgically broken, re-angled and re-set, there is the potential for problems down the road.
In these more involved procedures some type of hardware is usually implanted to hold the re-angulation in place. This would include screws, screws with plates, along with wires. I am also assuming here that you
did not have an implant (artificial joint) performed on the bunion.
If there is hardware implanted in the foot, over time it can loosen up, particularly screws and they can start to back out and feel hard against the skin. I have to mention, though, that most screws used in bunion surgery are placed through the top of the foot, so if they were to back out, you would notice a lump on top of the foot, which is not your situation.
In addition when a bone is surgically broken in an effort to re-angulate it, sometimes the fractured ends of the bone will overgrow new bone as the bone heals and people can feel a lump, which is actually more bone than should have formed. In most cases, this phenomenon will occur long before 15 years, usually a few years after surgery.
The possibility of a bone chip from the previous surgery could also be occurring but once again I would think you would have noticed this long before 15 years.
The last thing that comes to mind may be a sesamoiditis. You can read about it by finding it on the navigation bar to the left.
The sesamoid bones are two small bones that are just underneath the big toe joint. Because of their location they can become painful. In some situations as people lose fat on the bottom of the foot as they age, the bone becomes more prominent and can be become painful. Pressing on the area will give the feeling of pressing on bone as well as pain.
Obviously, I am just making educated guesses here and the fact that you are going to see a foot specialist in your area is the right thing to do.

Marc Mitnick DPM
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Jul 18, 2012
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Update
by: Melissa

So he took an x-ray, and everything seemed OK on it. He said I have an extra bone in my foot (I guess you were right? sesamoid?) and that could be what's causing the pain. He put me on an anti-inflammatory for a month to see how I feel.

Hi Melissa,

If he determines that the sesamoid bone is the issue and the anti-inflammatory do not help or only help modestly or the pain comes back after you finish them, I would suggest you ask the doctor about some kind of orthotic device to take pressure off the sesamoid.

Marc Mitnick DPM

Jul 11, 2012
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Response
by: Melissa

The bunion surgery I had, he re-aligned my toes. I'm not 100% on all the details because I was 11, but my big toe was turning into my 2nd toe so he did have to cut/shave/reset the two toes to lower the 2nd toe and straighten the big one. He did put a pin in it, but he took it out when the cast came out. I believe that was all he did.
Thank you for answering!
-Melissa

Hi Melissa,
Unless you were walking around in agony back then, I have never heard of operating on a bunion in some one so young. At the very least we like to wait until after puberty when the bones have stopped growing.
I am not sure if that factors into why you are having pain but would be interested in hearing what the podiatrist has to say after you have had your visit.

Marc Mitnick DPM

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