by Christine Bradley
runner with pain on top of big toe and underneath big toe
I have pain on top of my right big toe as well as underneath it. Here's background info. I had bunion surgery around 1994. It got stiff had cortisone shot 1995 and then another 1996 in which my toe was pulled out and bent back and forth. I started to wear inserts. I started competitive running in 2005 and have completed 4 marathons 2 of them have been Boston. I have had no problems until 2007-2008 pain in toe joint started to bother me. xrays show arthritis. I went to chiro and acupunture in 2008 to get me through my Boston training. In June 2008 I got another shot of cortizone in the toe joint. I started having problems with sharp knife pains in toe joint that started in October 2008. I went to a physical therapists who got mobility back in my toe joint but I started to have pain on top of the big toe and underneath. I went to a podiatrist got a block in toe joint and he pulled it out and bent it. Xrays showed not much change with arthritis and I could see the narrowing of the joint. I took 4 days off running. I started to run 5 miles and no pain. I did this 2 days in a row. The run was good but when I walk before or after I have pain on top and underneath toe. I have been xtraining and running every other day. Today was my first attempt to do a long run. I could only do 9 miles and the
pain was bad that I had to walk/run. The walking even hurt. I was on motrin 600 2 times a day. I did stop. I have been to 3 Doctors and they all explain a different surgery. I want to be able to run and I think that it could be a tendon or something. I would appreciate any help.
I tell my patients all the time that feet are like tires on a car, eventually they wear out. With your athletic background you have really put your feet to the ultimate test.
Evidently the big toe joint is worn out and you have limitation of motion in the joint which does not allow the joint to function properly and in that situation the accompanying structures like tendons and ligaments are put under extra stress and the area hurts.
You know, you can only patch a tire so many times, you may have reached the point where the big toe joint needs to be surgically repaired.
There are a number of bunion procedures out there and they all have different criteria for their use.
My best advice is that out of the three doctors you have seen, chose the one that has given you a thorough explanation as to why the procedure he or she is choosing is best for you, and go with it.
Keep in mind that surgery is not without its own inherent risks, but if you want to be able to run pain free again, then that might be your only option.
Read my section on "surgical considerations" to help you make a decision.
Marc Mitnick DPM