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sharp pain in 2nd toe after bunionectomy

by marisa
(Brooklyn , NY)

metatarsal parabola and bunion surgery

metatarsal parabola and bunion surgery

I had bunion surgery -right foot -on November 2016 - no complications - I am now having very sharp pain in the 2nd toe, especially when I walk.


RESPONSE

Hi Marisa,

Just to give you the quick disqualifier, there could be a multitude of reasons why your second toe hurts and I really have no idea because I have not examined you or even seen x-rays.

The reason I am responding to your question is that pain in the second toe can occur after bunion correction and for that reason I thought I would mention what can happen.

Of course, I have no idea what type of bunion procedure you had performed, and I even suspect the bunion area feels fine, but now there is pain in the second toe. There can be a correlation.

In any event this discussion is only pertinent if you had an osteotomy performed on your bunion. An osteotomy is a procedure where your surgeon surgically broke your bone and rearranged it in an effort to better align the first metatarsal and the big toe.

If you notice the diagram I have included, when we evaluate feet, one of our considerations is the parabola or arc that is formed by the heads of the metatarsal bones.

Note the blue lines. From them you will see the second metatarsal is the longest. It is like this for the majority of people, the only difference being the length of the second metatarsal.

Some people have very long second metatarsals while others have what is known as a short first metatarsal.

In either situation this puts added pressure on the second metatarsal head when we ambulate.

One of the effects of a first metatarsal osteotomy is that it further shortens the first metatarsal. So in essence if you had a
very long second metatarsal before surgery, (or even a short metatarsal), the procedure further worsened that discrepancy resulting in more pressure on the second metatarsal bone and thus your pain.

If you did have an osteotomy then I would recommend you continue reading. If you did not have an osteotomy, then I have no idea why you have pain in your second toe and it would be wise to have it addressed by your doctor.

Based on my math it appears that you were relatively pain free for two months post surgery, so I do not think the pain could be from the cutting of any structures inadvertently during surgery, otherwise you probably would have had pain all along.

The problem with the scenario that I have described with an osteotomy is that in some individuals the pressure can be so severe that you may suffer a stress fracture of the second metatarsal. If the fracture is close by the toe, it could feel like the toe is actually hurting.

So again, if the scenario I have played out sounds like you, then you would need an x-ray to rule out fracture.

Even without a fracture, there can be pain just from the excessive pressure. Does the bottom of your second toe and metatarsal feel swollen and inflamed? Are you starting to develop a callus under the second metatarsal? These symptoms would suggest too much pressure.

This new bone alighment may also lead to a condition known as capsulitis, which you can read about on this site.

In any event, if this sounds like your problem and if it is persisting beyond lets say one week, you should check in with your surgeon and let he or she know what is going on. There is treatment for this situation.

Marc Mitnick DPM
DISCLAIMER

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Nov 10, 2017
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Pain after bunionectomy
by: Ana

Hello Marissa and Dr.,

I have had my osteotomy (Chevron, combination austin-type) summer 2017. So now I am on >1 year recovery. The outcome of the surgery seemed great, the healing was good but since after 5 months after the surgery I started to get more and more pain. 1st under the 2nd metatarsal like you Marissa. The pain is really awful, I cannot even stand barefoot on the foot without pain! Not to mention the walking barefoot (impossible now because the whole rolling of the foot is happening only throgh the 2nd metatarsal!). 2nd I developed a sesamoiditis (I had sesamoiditis of the medial sesamoid before the surgery and light hallux valgus so the surgeon suggested that through this surgery the pressure will be taken away from the inflamed bone.). This bone still hurts a little, but now, since 2 month, I developed sesamoiditis of the lateral bone (it hurts even without walking), and it is seen in the MRI and CT (sclerose of the bone).
All in all, I am worse now than before the surgery.
Ah, and 3rd, the scintigraphy showed also a light inflammation around the screw (collection of radioactive substance around the screw).
The surgeon who performed the surgery still cannot believe that i have any pain and doesnt suggest anything. So I eeny to another one, he suggests removal of the screw and removal of the lateral sesamoid bone. And eventually shortening of the 2nd metatarsal. But he cannot guarantee whether any of this steps will relieve the pain. Could someone help me with an advise what I could else do? I am really just so sad because i have been doing sports every day before the 1st inflammation of the sesamoid and the surgery.
Thanks a lot in advance,
Ana
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The only doctors who can help you are the ones that can examine you and look at all your imaging results. If you are not happy with the advice the second surgeon gave you, then the best advice would be to seek out the opinion of another surgeon.
The more surgery you have, the more complicated the problem becomes, so be careful.
Marc Mitnick DPM

Feb 16, 2017
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2nd toe pain
by: Marisa

Dear Dr. Mitnick ……thank you for taking the time to respond to my inquiry……you have BRILLIANT insight and have been a tremendous help, much more than my DPM. I am scheduled for a 2nd opinion. Thank you, again!
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You are welcome. Good luck.
Marc Mitnick DPM

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