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The response to the question below was authored by Marc Mitnick DPM
Pain in 2nd toe post op. - bunion surgery
(North Carolina )
Hi Dr Mitnick,
I had bunion surgery (osteotomy/chevron cut) on March 2017. Since the surgery, I've developed metatarsalgia at the level of he 2nd and 3rd metatarsal heads( 2nd being worse). It's very uncomfortable to walk barefooted or with any sandal that doesn't have added cushioning. Running is no longer an option and walking more than a mile causes discomfort. I've always been very active, working out 5 days per week. I've had to modify my workouts. I do have custom orthotics and try to wear them as much as possible but still have some pain. I've had pain in my 2nd toe when wiggling it and pushing it towards the floor. Not so much pain when bending it up. I have very good motion in my big toe. I noticed this and asked my surgeon about the pain in my 2nd toe six weeks post-op. He mentioned reattaching a ligament. His PA also mentioned this during a follow up visit. Now the 2nd toe looks to deviate towards the big toe. There has been some concern that this may get worse and may result in a hammer toe. Is this common after bunion surgery and any suggestions on resolving without surgery?
All X-rays have been normal and my MRI is normal but showing my 2nd toe deviating towards the big toe. I've had 2 injections in the joint with relief for approximately 1 month but the pain along the bottom of my foot (2nd and 3rd metarsal heads) always returns. Even if I wear my custom orthotics and walk for more than a mile, I still have pain. I got a 2nd opinion and he suggested surgery to shorten the 2nd metarsal bone and re-align/straighten the 2nd toe and possibly put a pin in it (this will be removed 6-8 weeks later.).
I'm very nervous about the surgery and don't want to jump into it if there are other options. The physician that provided the 2nd opinion didn't immediately suggest surgery and was honestly hoping the MRI showed something to explain the pain in my 2nd toe.
I appreciate any advice.
Johns Hopkins Medicine
University of Rochester Medical Center
American Academy of Pediatrics
Penn State Medical Center
National Institutes of Health
Columbia University Department of Rehabilitation
Stanford Health Care
Illinois Bone and Joint Institute
Mount Sinai Hospital
Institute for Chronic Pain
University of Florida Health
American Family Physician
University of Maryland Medical Center