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Screws shifted 4 months after bunionectomy surgery

I had a bunionectomy, hammertoe repair and some tendon work done 4 months ago. I have not yet been totally pain free and the all my toes, but my big toe, look deformed. However, I just recently started having the original pain in the ball of my foot when walking, along with aching when sitting. So I went back to my surgeon who took an x-ray and said that my screws have shifted slightly and the toe which the hammertoe fix was done on is not laying down correctly. As of right now he is having me use an inflammatory ointment to get swelling down and taping my hammertoe toe slightly downward to try to get it to lay down and put an insert in my shoe to try to get pressure off the ball of my foot. I then go back in two weeks.

My question is, will this fix the problem and should I be more concerned about he screws moving after all this time? He asked me if I had an accident, which I have not.
Please let me know your thoughts. Thank you.

RESPONSE

Hi,

I should start out by saying that without actually examining you, I am only guessing what may eventually happen.

Having said that, the fact that four months has passed since the surgery is not a good sign in terms of your prognosis.

At four months post surgery, most of your swelling should be gone. That is not to say that the foot will not swell from time to time, particularly if you are on it quite a bit. The point is that four months down the road, if the hammertoe which I am assuming was done on your second toe, is lifting up in the air, chances are it is going to stay that way.

Taping can help, but usually if the toe is taped immediately after surgery, not four months down the road. If your doctor has ascertained that the swelling on the bottom of the toe is part of the problem, I would recommend considering a cortisone injection rather than using anti-inflammatory cream which has a dismal track record in reducing swelling.

If the insert has a metatarsal pad built into it, that could be helpful because essentially it raises the metatarsal bone just behind the toe and in doing so forces the hammertoe downward.

You do not mention per se, but I am assuming the screws that have shifted are located in the bunion and not the hammertoe. Some shifting can be a non-issue, while more shifting can end up being a problem. If the screws are in the bunion and if the bunion is now hurting perhaps more than it was two months ago, you might assume it is from screws that have moved too much. Again, I am only guessing since I cannot examine you.

Like I said earlier I am not sure the treatment regimen you are receiving will remedy your issues and if they do not to your satisfaction, you may be looking at additional surgery. This might consist of removing the screws if the bone is completely healed and may also consist of soft tissue reconstruction on the second toe, to bring it down.

Problems can and do happen in all surgery and foot surgery is not exempt from potential problems. As long as you trust your surgeon and he is willing to keep working with you to remedy the situation, then stay with him. If you have any qualms about the care you are receiving then the best move is to get a second opinion by another foot specialist in your area.

Marc Mitnick DPM
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