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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

Comments for Nerve pain developed in 2nd toe 5 months post bunionectomy

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Oct 10, 2016
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PAIN between big toe and 2nd toe after bunion removed
by: Debbie

that is exactly the pain i am having. it started the day i tried to wear my first pair of short pumps - 7 months after surgery. when my toes are in a shoe, it shoots a sharp pain between big toe and 2nd toe- i can't even walk when it happens. i am freaking out. i had bunion surgery on my other foot years ago and it is fine. .. never had an issue. i can't wear flip flops my entire life.. i have a job where i have to dress up. Even when i wear flats - wide ones.. my toes still come together and one wrong step or twist can cause the unbearable pain. i am going back to doctor this week. this sucks!

Jun 30, 2011
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A Year Later.
by: Sarah

Just thought I would give an update in case anyone would wonder how I turned out! After months of searching and appointment after appointment looking for a good Dr. I finally found someone who made sense and I felt like I could trust.

So I had surgery again in December 2010. He removed the nerve that runs in between my first and second toes. It had been damaged in the first surgery (bunionectomy) in May 2010. He said this happens in less than 1% of cases. It was enlarged.. a neuroma.

He also did a fibular sesamoidectomy because my big toe had started to turn inward much more than it even was before my bunionectomy.

So now half of my big toe and second toe are numb.. and an area on the bottom of my foot.

But my nerve pain is gone. And my big toe is straight and functioning well again!

So thankful for good Dr's. Thankful for healing.

When it comes to surgeons.. it pays to look around and find the best.

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