Hammertoe healed badly

by Amy
(Appleton, WI)

I am experiencing daily pain around the healing area of hammertoe surgery I had approx 7-8 years ago. The second and third toes were hammertoes my podiatrist “fixed” during a Bunionectomy on my right foot. There is a bony prominence (I’m told it’s a dome/donut shaped area where the bone ends meet) in the toe rather than a smooth area. This prominence causes pain between my great and 2nd toes. Severe pain and inflammation occurs at the site. I’ve used liquid corn remover in the past to help reduce the dead skin and swollen area; however, the last round isn’t providing any pain relief. The attached photos show my foot at different angles and skin sloughing from the corn remover. On another note, the bunion was “perfect” for roughly 2 years and is once again present. I also have a bunionette that was shaved during the Bunionectomy. It doesn’t seem to have helped much as the little toes is pressing into the 4th for and is more painful than the bunion! My orthopedic surgeon continues to bring up great toe fusion to stop arthritis forming but I’m not mentally prepared for the surgery as I lead a fairly active life. I became depressed during my Bunionectomy recovery and dread being inactive for the recovery time necessary. I exercise 5-6 Days/week as much for the mental aspect as the physical aspect.

Can you offer any suggestions for pain relief around the hammertoe area as well as the bunionette? Thank you!

RESPONSE

Hi Amy,

For some reason only one picture is visible to me and that is the one showing the inside of the second toe where you have been applying liquid corn remover, which by the way I would not recommend.

I understand the business about dome/donut shape of the bone on the second toe as that happens a lot. This bone protrusion is then pressing against the bone on the big toe and causing the corn and quite possibly an inflamed bursal sac. It is hard to tell for sure from the picture.

Let me start off by saying the last thing you want is repeated surgeries in the same area. In most cases the risk/reward ratio is not in your favor and most people just end up with more scar tissue and limitation of motion.

Having said that, let me start off by saying, unless the bunion joint is excruciatingly painful, leave it alone. Wait until it gets to that point, if it ever does, and then consider additional surgery. I personally hate fusions of the great toe joint as I think they create more problems then they solve. There are other surgeries out there like implants and joint remodeling that can also relieve pain without the horrible side effect of the joint being fused.

That still leaves us with the issue of the corn on your second toe. Obviously I do not have x-rays to look at or even the luxury of examining you, but as I have already stated this is usually a problem of the overgrowth on bone on the second toe, hitting an enlarged portion of bone on the great toe. Unfortunately, in hammertoe surgery, you sometimes get this overgrowth on bone.

Assuming that is true, if you came into my office with that kind of problem, I would suggest going in and shaving down the protruding bone on the second toe as well as the big toe. This way when you have shoes on and the toes press together, you have eliminated the bone to bone pressure that is causing the corn, and the corn disappears.

I have done this type of procedure dozens of times in my career and it is highly successful with very little down side. You end up with two small incisions and the great toe joint is not affected at all.

The only caveat here is that by looking at the picture, since you might have an inflamed bursal sac on the second toe, in addition to the corn, I might excise the whole corn and "scrape" down the bone from that angle, as opposed to going through the top of the toe which is the direction I usually go. I would do this from the side of the toe simply because if there is a bursal sac component to your problem, you might still have discomfort if only the bone is scraped down and the bursal sac is not addressed.

I do not think these kind of procedures are in the wheelhouse of most orthopedic surgeons, so you will probably have to find a podiatrist in your area and see if they are in agreement.

As far as your bunionette goes, I cannot see it on the supplied picture, so I really cannot comment on it.

Marc Mitnick DPM
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