numbeness, discoloration of toes, edema , radiating pain

by debbie
(south carolina)

In March of 2011 I had a left great toe fusion r/t Hallux Rigidus. Eight months after the surgery I had the screws removed. Since then my toes have been numb. I have swelling which varies from a little to a lot. There is a temperature difference in my left foot compared to my right (it is warmer to touch) My toes vary from discoloration (light blue to dark blue) My nail on my fusion toe is very brittle. I have pain that is burning in nature that goes across the ball and toe pads down the lt sole. Last week I experienced very bad ankle pain that caused me to barely be able to walk with a walker. I also have pain that is beginning to affect my lower shin. I went to the orthopedic dr. today and he did x-rays and told me the reason I had ankle pain was because of me walking on lt side of foot. He did not address my swelling or discoloration. He made me feel like an idiot. He gave me an ankle brace and told me to get better shoes. I am a dialysis nurse and I walk a lot of hours per day. I wear good shoes (Dansko) and why am I having problems with my ankle. I have been walking the same for last year. This pain in my ankle was very excruciating but aome what better now. I don't know what is going on with my foot and I am so tired of dealing with this pain.

RESPONSE

Hi Debbie,

There are a couple of issues that I would like to address here.
I have never been a big fan of great toe joint fusions for the simple reason that movement or lack there of in that joint is critical in moving from point A to point B. I am not going to second guess your surgeon for why he chose this procedure and I will also say that it is done quite frequently in those with a painful first metatarsal-phalangeal joint. You do not mention what type of previous treatment you had for the painful joint so I do not know if the procedure was justified or not (in my criteria).
Anyway, whenever you have a joint fusion, that tends to place greater stress on the joints adjacent to the fused joint. A fused great toe joint is certainly going to change your gait and in doing so can have an adverse effect on the way you walk. Additionally, if you are still having pain in the surgical site, that too will also change the way you walk.
I will also assume since you are a dialysis nurse you are on your feet quite a bit during the course of the day.
All these factors combined certainly could change your gait and thus cause your ankle to begin to hurt.
Your surgery was over two years ago and it sounds like you are having way too much pain relative to the amount of time that has passed. Again, because the joint was fused I would have never expected you to be 100 percent improved; what I would have hoped for is you being at least improved over what your foot was like prior to your surgery, and that is certainly not the case.
Here is the bigger issue coming from someone looking in on from the other side of the internet (so keep that in mind). The numbness, discoloration and temperature changes in the left foot versus the right foot is not normal. You did not have that much surgery on the foot to warrant that kind of response and certainly over two years down the road you should not be having this type of problem.
Now, it may be due to nothing more that you being on your feet a lot as a nurse, but, I think it is important that you be examined for the possibility of CRPS, Complex Regional Pain Syndrome. You can read about CRPS by finding it in the navigation bar to your left.
This is a condition your orthopedist probably will not be able to make and is more readily diagnosed by a neurologist or pain management specialist.
I think that possibility needs to be ruled out because of its potentially devastating consequences.
If CRPS is successfully ruled out then physical therapy and perhaps an orthotic may prove to be very helpful in reducing some of your symptoms and making your foot more functional.

Marc Mitnick DPM
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