Pain in toe ten years after bunion surgery

by Naisha
(Clifton Park, NY)

So I had a Bunionectomy done and set with a pin about 10yrs ago. For the past year I have been having pain and redness at the ball of my toe and the top of my toe where the scar is, off and on, more so when I’m standing or walking on it for a long period of time, just a few days ago I banged it pretty hard and the pain came on and has not gone away. I went to an Ortho Urgent Care and they took an X-Ray, the doctor told me the X-Ray’s came back fine and there was no sight of any fractures. I have been reading up on this Sesamoiditis and I’m concerned I could have developed this and just aggravated it more when I banged my toe. I have been taking an anti-inflammatory and I do wear Orthothics in my shoes and that’s because I am on my feet all day so I need the extra support, but once the pain comes there’s no helping it. Wondering if Sesamoiditis could be the problem and if I should see a podiatrist.

RESPONSE

Hi Naisha,

I will start off by saying I am surprised the doctor at the Ortho Urgent Care could not help you to determine the source of your pain.

The first thing you want to do is make sure the pin/screw has not moved as this can happen over time. If that is the case it could be causing pain either on top or the bottom of your foot in the area you described.

The next thing you want to consider is whether or not the trauma to your foot actually caused a small fracture. Small fractures may not initially show up on x-ray, but if your pain persists you might want a second x-ray in a week or two, or perhaps even a bone scan which is a test that is more sensitive to small fractures.

Since I cannot examine you and have not seen x-rays in reality I have no idea what is causing your pain, but I will say sesamoiditis is certainly a possibility, particularly if you spend a good many hours standing, even with orthotics. Sesamoiditis will cause pain on the bottom of the foot, but will not cause pain on the top of the foot.

Sometimes, particularly in trauma, the sesamoid can fracture and this type of fracture can be very hard to pick up on x-ray and in that case a bone scan would be indicated.

You should take the anti-inflammatory for at least two weeks (if there are no contraindications) along with icing the area whenever you have the chance.

If possible try and only wear rigid shoes that do not bend too much at the ball of the foot as this type of shoe will take pressure off of the sesamoid bones.

Keep in mind, the fact that you work long hours standing on your feet, only slows down the healing process. Having said that, if after two weeks you are not substantially improved, then yes, you should see a podiatrist in your area.

Along with sesamoiditis there are other conditions that may cause pain in that area of the foot. Additionally he or she should be able to determine if your pin has shifted, or even if the trauma you recently sustained when you banged your toe, caused some damage to the osteotomy site (the place where the pin was placed to hold the bones in place).

Marc Mitnick DPM
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