Waiting for knee joint replacement, but broken great toe

[petuniafish]

November of 2008 my husband and I spent 2 weeks in Italy followed by a 2 week cruise. I proceeded on the trip knowing I had a torn medial meniscus- 3rd time in one year. My leg was flopping around and giving out the whole time (we should not have gone-it was all paid for- would have lost all our money) I fell hard on my knee several times during the course of the trip.

One day on the cruise I fell hard. I was bleeding from legs, arms and head and both knees. Saw ships doctor. Broke left great toe, same side as my bad knee. I am an RN and knew there was nothing to be done but wait on the great toe. The ships doc never took Xrays. And when I went home did dot tell my ortho figuring it would take a few months for the toe to heal.

I had surgery on my bad knee two weeks ago- it went well but found out I need a knee replacement- and SOON in order to keep my job. But that great toe and area immediately above the great toe, I believe the metatarsal, is terribly painful, very swollen and red- worse than it was when I broke it. The great toe is now deformed and metatarsal area huge.

Because my knee is so painful I placed the toe on the back burner but now finding my whole foot is sore. It's painful to walk not just because of the knee but my foot too. Jeez.

During knee surgery almost two weeks ago my anesthesiologist gave me some dexamethasone, an anti-imflammatory which worked wonderfully for my toe. My ortho and anesthesiologist didn't know about the toe, gave me dexa to help with post-op pain. For about a week after the surgery my toe and foot did not bother me at all. Now it's extremely painful again. Guess the anti-inflammatory worked.

Whats going on? Why didn't this heal by now? I have to prioritize and my knee comes first. But who do I go to now for pain relief in the meantime, podiatrist or ortho? I am thinking I just want some steroid injections in the toe-metatarsal area til I get my knee fixed. Is that reasonable?
Thanks........Nancy

[FootDoc]

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First of all, your belief that nothing can or needs to be done for a fracture of a great toe is absolutely incorrect. That might be essentially so for most lesser toe fractures, but not for one of the great toe, as it is the only truly biomechanically functional toe on each foot. It is essential that a suspected fracture of the great toe be definitively identified and appropriately treated, and I would venture a guess that in light of your subsequent experience, you probably now agree with me. What is now going on is anyone's guess without an actual evaluation, which apparently you have yet to obtain . . or somehow neglected to mention it. The fact that the toe is now deformed would seem to give substance to my opinion that it needed evaluation from the get-go as well as treatment dictated by the results of that evaluation. I gather that you are using the terms, "heal" and "becoming symptom free" as synonyms, unless you are saying that you have a non-union of the fracture site. But how would you or I know that, as you have mentioned no examination and even stated that your orthopedist was unaware of the toe problem, though I don't know why you would not have shared that with him/her. I don't think that you should target your seeking of care to merely pain relief, but actual correction of the neglected toe problem precipitating it. From what you have said, I doubt that cortico-steroids will result in extended relief and certainly not a cure. You will have to allow the doctor whom you select to treat the toe determine if such injections are appropriate and for how long. Whether you choose a podiatrist or an orthopedist should not be a factor, but your choice of a doctor should be for sound medical reasons such as credentials and peer recognition.

[petuniafish]

Thanks very much for your help Foot Doc. What a dummy and this is not funny.
I was told by an orthopedic surgeon (not the ortho who did the knee surgery) but one I work with in an ER, that there was nothing to do with the great toe but wait two months for it to heal. I have heard that advice given to patients before and believed it to be true, It's exactly two months and now it is deformed and painful. I should have mentioned it to my ortho before surgery. But in my defense the knee pain was distracting me from the foot pain. The night before surgery I showed my husband my toe and swollen foot. We were both shocked. I'd been walking around thinking the foot pain was referred pain from my swollen knee. I never bothered to look at my foot.

I'll get this examined and reset priorities. Very appreciative of your input. Thanks for the gentle reprimand.
Nancy