Pain after amputation of 3rd toe from a crushing injury.

by Jill
(Milford,Ct USA)

Had an oak bench fall onto my left foot 1 1/2 years ago.A podiatrist removed bone fragments with surgery,then therapy. Toe started losing circulation and foot still hurting. 3 months later had 1/2 of toe removed,more therapy.No difference and toe now turning blue.2 months after that complete amputaion of toe.Return to Dr. 3 months later for cortisone injection to relive pain in ball of foot and top of foot near scar pain. Does not work. End up having alcohol injections. 7 of them at 2 week intervals. Hurts worse than before. Take an x ray told foot is fractured and given walking cast. Go to another podiatrist who takes more x rays and an MRI. Results come back clear,more cortisone in same spot with a diagnosis of a hammer toe in the 2nd toe. Told to wear orthodics and buy good sneakers and shoes . Get both,pain increases. Go see an Orthopedic podiatrist who diagnoses me with reflex distrophy. He sends me to a Physical Medicine guy how says that's not what I have. Prescribes me Pain patches of Licoderm . Patches help minutely. Will I ever be pain free? Please help me.

RESPONSE

Hi Jill,

Will you ever be pain free? Hard to answer because in reading your narrative it seems you have been given every diagnosis possible and none of it along with treatments has rendered you pain free, or even reduced pain for that matter.
I do not know how old you are or any other medical issues you may have so that makes my job even more difficult.
The two things that come to mind in light of your amputation are as follows:
1. you may have a nerve entrapment at the end of the foot where the toe was removed. Sometimes when the nerve is severed (as is necessary with an amputation) the nerve can get caught in the scar tissue that naturally forms. This can and will cause pain. It will be neurological pain, like tingling, burning, numbness, etc.
That is probably what the podiatrist was thinking when he gave you the denatured alcohol injections.
2. A biomechanical problem meaning with the amputation of the third toe the dynamics of the way the foot functions is altered. In general terms most people who have one lesser toe amputated do not experience much change in their gait or even an alteration in the function of the forefoot. Could you have developed a second toe hammertoe as the result of the third toe amputation? Possibly, but in that case your pain would be more in the area of where the second toe articulates with the second metatarsal bone.
I will make the assumption that you do not have pain in the area of the second toe and your pain is in the part of the foot where the third toe used to articulate with the foot.
So that puts us back to a nerve entrapment. (This of course assumes your circulation is normal).
I understand the cortisone injections and denatured alcohol injections did not work. If indeed it is the nerve that is causing your pain and this can be verified by a doctor, then you might consider having the area opened up to see if the nerve can be separated from the scar tissue.
If that does not sound appealing to you then you might consider another round of denatured alcohol injections, or continue with the lidocaine patches.
You might even consider asking your doctor about some of the medications out there like Lyrica which is for nerve pain. If you were to try one of them and they worked two things would be accomplished. One, you would have pain relief and two, you would know the source of your pain is neurological in nature.

Marc Mitnick DPM
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