Nerve pain developed in 2nd toe 5 months post bunionectomy

by Sarah
(Minneapolis, MN)

I had a bunionectomy done in late March 2010, and also a tailor's bunion corrected at the same time. It was actually the tailor's bunion that was giving me pain and causing me to limp. But the Dr mentioned it could be good to go ahead and fix the bunion at the same time since we're already doing surgery on that foot. I asked him if anything would be different about the recovery and all he said was that I would need to do ROM on the big toe.

Well now it's 5 and a half months later and I'm really wishing that I just did the pinky toe. Why wouldn't he have encouraged me to be more conservative about the big toe?

So my problem now is that the nerve in my first intermetatarsal space is giving me problems. I remember about 3 months after my surgery when I would plant my foot in a sloppy way I would feel a nerve stimulation on the bottom of my foot in between my first and second metatarsals. Nothing painful at all.. and I just figured it was my foot adjusting from surgery still.

But now 5 months out from the surgery, it feels like a shard of glass is being pressed into the side of my 2nd toe. I can also get a feeling as if the nerve is being twinged on something if I move my foot a certain way. Or if I roll my foot around on the ball of my foot.. I can feel some clicking in the joint and that stimulates a shooting nerve pain down the inner side of my big toe. I also have some muscle twitches of my 2nd toe and of the muscle that is in my arch under my first metatarsal.

I went back to my surgeon and told him of my problem. I wondered if I had developed a neuroma or if the screws were irritated the nerve somehow (high hopes that this was the problem!). He said in his 20 years of experience he has never seen someone develop a neuroma in the first intermetatarsal space after having a bunionectomy. And he said the screws are no where near that nerve and wouldn't be causing the problem. And he said the twitches aren't related since the nerves that control those muscles are in the leg.

So I asked him what is causing the problem! He said he thinks my foot is just learning how to walk a new way since the bone structure is different, and it's irritated that nerve. He said everything felt great structurally and my ROM is excellent.

He gave me a shot of cortisone and said to give it two weeks. The anesthetic in the shot made the foot feel heavenly for those first 12 hours or so! But then the nerve pain came back (of course) when the anesthetic wore off. He seems hopeful that everything will be fine. He actually seemed a bit annoyed that I was so worried about it. Now it's 1 week after the cortisone shot and it is still bothering me. I feel like it is getting better some days.. but then the next day it will still hurt. Again, like sharp shards of glass pressing into my toe.

I am going to get a 2nd opinion, if anything just to make sure that the surgery was done correctly. And to hopefully get some more ideas about why I am having this problem.

I want to have hope that this is just a temporary challenge and soon my foot will be feeling well. But to be honest I am having a hard time feeling trusting towards surgeons now. Is it likely that this nerve problem can be fixed without any other complications? What should I do? What do you think the possible outcomes are with this problem?

Hi Sarah,
The phrase I use a lot in my practice is "if it ain't broke, don't fix it" for the obvious reason that sometimes in spite of a surgeon's best efforts, complication arise as is the case with your bunion surgery.
In my opinion the most likely cause is nerve irritation as a result of the dissection and retraction of tissue, during the surgery. Additionally, there is the possibility that the nerve in that area is embedded in tissue that is beginning to scar and thus put pressure on the nerve.
I agree that you need a second opinion to get a best "guess" as to what is actually causing the problem. Because you mention that the problem began three months after the surgery I would venture to guess that it is scar tissue that may be causing the problem.
If your second opinion agrees with that assumption then you will need more aggressive treatment in an effort to prevent more scarring, rather than taking a "wait and see" attitude.
Marc Mitnick DPM