Bone non union following bunionectomy

(Illinois)

Hello! I am the person who previously asked you about the staple that broke in my foot 3 weeks after an Austin bunionectomy. My doctor put me in the boot to immobilize the foot for 6 weeks. At that time he took an X-ray and said the bone was healing. He allowed me to return to wearing good supportive shoes with new orthotics. That was six months ago. I continued to have pain and swelling in the foot and returned last week to my physician. X-rays show incomplete bone union. I have been instructed to wear a post op shoe 6 weeks and call the doctor at that time to report my progress with the pain and swelling. I am skeptical that the shoe stabilizes much of anything as I feel my foot moving quite a lot in it and still experience pain and swelling in it. I have very flat, hyper mobile feet, and I also have anemia and osteopenia. Could any of these conditions be a contributing factor to the delayed bone healing? Will the post op shoe provide adequate support and immobilization for the foot to heal?

RESPONSE

Hi,

Sorry, I do not remember your previous post and would like to for the simple reason I would like to know the total amount of time that has passed since your surgery.
Based on this post it seems to be about eight months from the original surgery.
If that is the case then you have a non-union and the chances of the broken bone healing on its own is pretty nil. I agree with you that a surgical shoe is not going to be much help, but even in a cast the probability of the bone healing would have to be considered low.
You also happen to be correct in your assumption that your anemia and osteopenia is working against you.
Bone with diminished density has a lower success rate in healing fractures. Blood nourishment is the way broken bones heal and if you are anemic, that too will work against you. Additionally, if you happen to be a smoker that will also work against you.
So what options do you have?
Depending on the degree of non-union will determine on what you can do. The two major factors are the amount of open space between the two ends of bone and secondly the type of non-union you are experiencing.
There are two types: one, is what is known as a hypertrophic non-union where on x-ray you can see a lot of bone growth around the fracture, but, the fracture still does not heal. The second type is known as atrophic non-union where in this case there is virtually no bone bridging noted on x-ray. I am just guessing here of course, but I would imagine you are probably experiencing this type of non-union because of your osteopenia.
This leaves you with two options. The first would be the use of a bone stimulator which is a device that you wear constantly and has electrodes that are placed on the foot on either side of the fracture. The stimulator sends a charge across the fracture site in an effort to stimulate healing. Over the years I have seen excellent results with a bone stimulator but they tend to work better in hypertrophic non-unions.
If that is not an option for you then you will be faced with a second surgery that will require a bone graft and re-fixation of the old fracture site.
I am only getting your side of the story and I cannot possibly know what your surgeon is thinking, but it seems to me you have not received the best advice up to this point.
I would suggest before making any decisions, you go for a second opinion to a foot specialist in your area, as that would make the most sense.

Marc Mitnick DPM
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