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I have Osteoporosis and Bunions.

by Michelle

Dr. Mitnick,

I could really use your advice right now.
After having bi-lateral 2nd metatarsal stress fractures 6 months apart, I discovered that I had Osteoporosis. I received a Reclast infusion in February of this year, and have been taking 1500mg of Calcium and 1000mg of Vitamin D two times a day. I also transfered to a sitting job when my workman's comp claim proved that I received the stress fractures because of my previous working environment.
I am 32 years old, have flat feet, bunions and hyperhidrosis which do not help to improve my current situation. Since my bunion pain has been steadily worsening since my stress fractures and Osteoporosis diagnosis, I decided to ask my Podiatrist about having bunion surgery.
With my DEXA scan numbers showing Osteoporosis in my neck and spine and Osteopenia in my pelvis, my doctor felt that I should wait for my DEXA scan numbers to improve before he would consider doing the surgery on me. He checked my x-rays from 2011 and determined that my bunions were large and the surgery I would need would require NWB for 6 weeks. I would require screws in my 1st metarsal and he wasn't sure if my bones would be strong enough to support the screws and hold them while my bones healed.
My question is this...If my doctor put my foot or feet in a cast, after the surgery, would that be enough to stabalize my foot so that the screws would stay in place while my foot heals? In a cast my foot would be immobile so his concern of the screws moving and my alignment being compromised would be alleviated?
I can understand my doctors concern, but I really don't want to have to wait.
Thank you for your help,

Hi Michelle,

In theory, if you were in a cast it would not put undo pressure on the screws and you would assume that would be helpful. BUT, in reality, immobilization in a cast for six weeks might also worsen the osteoporosis in your foot and lower leg.
So, as I see it, since you are young, you could wait and see if the osteoporosis improves or you might consider a lesser procedure that might relieve your pain although cosmetically the foot would only "look" marginally better. A lesser procedure would not require screws, so healing would not be an issue.
I have operated on a lot of bunions over the years and have never had one that was an emergency surgery. You mention you have flat feet. Wearing an orthotic which would better align the bunion joint and wearing wider conservative shoes may also give you sustained relief until you are a candidate for a more invasive bunion procedure.
Without the luxury of examining you or even seeing your x-rays, I do not know that I can be much more help than beyond what I have just stated.
Speak to your doctor and if necessary get a second opinion from someone in your area.

See related article.....osteoporosis

Marc Mitnick DPM

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Oct 20, 2012
Scheduled for surgery
by: Michelle (Colorado)

I am scheduled for my first Austin Bunionectomy next week.
I went for a second opinion, from a doctor that knows and is friendly with my other doctor, and he saw no reason to indicate that I should wait to have the surgery.
I am not exhibiting joint deterioration and my x-rays show that my feet have plenty of bone and are not cloudy from a lack of adequate bone mass.
My new doctor mentioned that I was scheduled for surgery, to my old doctor, at a conference they were both attending and he was fine with my decision. That made me feel better, because it was not my intention to insult my first doctor.
Thank you again for listening and I hope you have some happy holidays coming up. Michelle

Sep 28, 2012
Thank you for your response!
by: Michelle (Colorado)

Thank you for answering my question.
Since I am a younger woman with Osteoporosis, I have not an easy time finding information that pertains to premenopasal cases.
As I have said before, your sight has invaluable to me and given me the kind of information I have been unable to find elsewhere.
My next move is to get a second opinion from another Podiatrist. I will see what they have to say about less invasive alternatives.
In the mean time...I am greatly reducing acidic foods and drinks from my diet. It was something that I never given thought to and am now realizing has quite a bit to do with my bone loss.

Thank you again and I will keep you posted.

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