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The response to the question below was authored by Marc Mitnick DPM
persistent foot pain even after two surgeries
Dr. Mitnick, Thanks again for your reply. Sorry if I'm not explaining this really well. I first went to the dr. because of the terrible bunion pain. The bunion was really bad and it hurt constantly. After the surgery, I had this arch pain that I didn't have before. I also had started to have the outside/top of foot pain. I went back to the dr. after a year of this. I gave it a year because I know it takes time for stuff to really heal. The dr. did xrays and thought the screw that he'd put in during bunion surgery was causing the arch pain because it was loose. I thought that was it too. He thought the pain on the outside/top was caused by a neuroma so he removed it when he did surgery to remove the screw. Now I not only still have the other pain, I also have the nerve stump pain on the bottom of my foot which I didn't mention before because I know it takes time to heal and its only been a little over three months. Also now I'm dealing with the numbness of two toes but I can stand that. It's just that the arch of my foot continues to feel like its cramping all the time and the outside/top behind my little toe just aches all the time. It's not as bad if I'm not on it but when I am its constant. My toes are all pretty stiff and won't bend very far. I try several times a day to move them as much as possible because I'm sure if I don't the stiffness will only increase? Again, thank you so much for your time and
help. I appreciate it very much.
OK Debbie, the time line of events is starting to make some sense to me. If you are having the type of arch cramping pain that you describe and an x-ray shows no abnormality then I would get an MRI to examine all the soft tissue of the foot. Since I do not know exactly where in the arch your pain is the screw might have been the culprit and certainly was justifiable removing it solely on the basis that it was loose (and would be an issue sometime down the road). If your arch pain is near the area where the screw was placed then there is a possibility there was soft tissue damage as a result of the original surgery and an MRI would pick that up. That soft tissue damage might be the cause of your arch pain. Constant "cramping" may also be a symptom of nerve damage so that would have to be ruled out.
As a result of your neuroma surgery you may be left with a stump neuroma , which is a very common complication of neuroma surgery. You are right, it is only three months and you may have further improvement there as well. If not, I find that denatured alcohol injections can be very helpful in relieving that pain.
So in summary, have an MRI, try an isolate the structures of the foot that are causing the pain, if it is only soft tissue damage physical therapy may still be of benefit. Let me know the results of the MRI. (include this post with the MRI results; I answer so many questions, I do not want to get my answers confused)
Marc Mitnick DPM
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