Not what you're looking for? CLICK HERE INSTEAD



Pain 8 months after surgery, but no inflammation?

by Jim
(California)

Greetings Dr. Mitnick,


I had bunionette surgery on left foot roughly 8 months ago, but for some reason the foot still hurts whenever standing or walking (often with some pain also when not on my feet). The pain is mainly on and around the osteotomy area (with extra pressure there).

I have had my foot examined by three foot specialists and none of them could tell why it still hurts.

X-rays look normal and I had an MRI (multiplanar, multisequence with and without IV contrast); the "Result Impression" was:
1. Status post varus and lateral resurfacing osteotomy of the distal neck and head of the 5th metatarsal with residual postsurgical changes.
2. Mild dorsal subluxation of the 5th proximal phalanx with poor visualization of the plantar plate.
3. Bipartite medial hallux sesamoid with trace edema in the proximal pole.
4. Nonspecific edema in the tuft of the 1st distal phalanx. Correlation with plain film is recommended.

From what I can tell, there is no inflammation found in the osteotomy area (only some in the big toe).

What could be causing this aching pain around the osteotomy area whenever I stand or walk?

Could the "residual postsurgical changes" (#1 above) have anything to do with it?

I use orthotics and they help, but not enough (still pain and discomfort when walking or standing).

I am concerned that it still hurts and does not seem to be improving (been about the same for the last 5-6 months).

Have you seen this kind of situation before?

What would you recommend?

Thanks,
Jim

RESPONSE

Hi Jim,

One would hope that eight months down the road you would be looking at this surgery through your "rearview mirror" and unfortunately, you are not.

Obviously, I am at a distinct disadvantage because I cannot actually examine you but perhaps I can offer a little insight and you might go back and get verification from one of the foot specialists you have already seen.

"Status post varus and lateral resurfacing osteotomy of the distal neck and head of the 5th metatarsal with residual postsurgical changes." What this means to me by post surgical residual changes is that perhaps the osteotomy is not completely closed. An MRI would be better at picking this up than an x-ray.

If the osteotomy is not completely closed then that could be one factor that would account for your ongoing pain. The only other postsurgical change that I could imagine a Radiologist seeing would be post operative edema and he makes no mention of that, yet, does mention edema in a different part of your foot.

The Radiologist also goes on to mention "Mild dorsal subluxation of the 5th proximal phalanx". That means the fifth toe is riding up the head of the fifth metatarsal. I would be curious to see pre-operative vs. post-operative x-rays to see if the dorsal subluxation is the same, or at least very close to it.

If there is greater dorsal subluxation post-operatively then that would suggest to me that when the osteotomy was performed, not only was the head of metatarsal slid over closer to the fourth metatarsal, but also plantarflexed somewhat, meaning the head of fifth metatarsal was pushed downward. The consequence of this would be more pressure on the head of the metatarsal when it hits the ground, which might translate into pain.

I do not mean to imply this was done intentionally by your surgeon, but if the osteotomy cut is "off" just a little, something like that could happen. So, if the metatarsal head is plantarflexed, it would cause the fifth toe to ride upwards.

Again, you need to compare pre vs. post-op x-rays.

The other possibility is that there is mention of "poor visualization of the plantar plate." The plantar plate is a ligament that attaches the fifth metatarsal head to the base of the fifth toe. If this was cut during surgery, that might also be the source of your pain. If you bend your fifth toe upwards and backwards, and are able to re-create your pain, then that might suggest a plantar plate tear. A tear of this ligament might also cause the fifth toe to dorsally sublux.

Lastly, with any kind of surgery there is also the chance of scarring in certain areas. If your surgical site has some excess scarring, that too, could cause pain.

In summary, the things I would want to rule out are the following:

1. incomplete closure of osteotomy
2. plantarflexed fifth metatarsal head
3. plantar plate tear
4. excessive scarring

Each problem would require a different treatment approach so that is why it is imperative to isolate the problem before undergoing any further treatment.

That is about as far as I can go based on your narrative.

Marc Mitnick DPM
DISCLAIMER


Comments for Pain 8 months after surgery, but no inflammation?

Average Rating starstarstarstarstar

Click here to add your own comments

Mar 28, 2015
Rating
starstarstarstarstar
One more question
by: Jim

Hello Dr. Mitnick,

One more question:
With the MRI not showing any inflammation in the area, would there be any point in trying a cortisone injection (for example, could there be inflammation not seen on the MRI)?

Thanks again,
Jim


All things being equal, I see no harm in a cortisone injection, but that decision is really up to your attending doctor.

Marc Mitnick DPM

Mar 26, 2015
Rating
starstarstarstarstar
Pain 8 months after surgery, but no inflammation?
by: Jim

Hello Dr. Mitnick,

Thanks for your reply.

Regarding #1(incomplete closure of osteotomy):
I will ask my podiatrist to request clarification of "post-surgical changes." But since the MRI was done due to pain in that area, I would think/hope that they would have reported an incomplete closure in more specific terms.

#2 (plantarflexed 5th metatarsal head)
Yes, the little toe hovers may 1/4" off the ground now (which it did not do before the surgery); the doctor says that it is mild enough to normally not cause problems. My own layman's feeling is that it certainly is contributing to the issue even though it might not be the main reason. I say that because the area seems just overly sensitive - even when I sit and rest my foot on the carpet, I avoid touching the 5th metatarsal area to the ground because it is a bit uncomfortable. With out this hyper-sensitivity perhaps the plantarflexion would not be much of an issue. Just my gut feeling...

#3 (plantar plate tear)
If I move my little toe up and down with my hand, it does not reproduce the pain.

#4 (excessive scarring)
I do not know, but wouldn't the MRI normally have picked that up? Either way, I will ask about this as well to be sure.

Thanks again!
Jim






Click here to add your own comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Ask the doctor.






download from Apple Store
Get it on Google Play



MY PRODUCT RECOMMENDATIONS
(items I prescribe in the office)


Orthotics for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


Orthotics for heel and arch pain for those who must wear dress shoes
click link below


redithotics


Topical pain reliever
click link below


blu-mjk


Relief for nail fungus
click link below


clotrimazoil


HONESTe Online Member Seal
Click to verify - Before you buy!






I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.

Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown