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Problems after bunion surgery

Discussion in 'Ask your questions here' started by Unregistered, Mar 6, 2010.

  1. Unregistered

    Unregistered Guest


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    Hello!

    I had an austin bunionectomy and modified mcbride bunionectomy (in one surgery) about a year ago. I had a k wire for four weeks with no internal fixation. My bunion wasn't that bad looking but it was more painful than anything.

    Since the surgery I haven't been able to bend my toe down. It bends up... Not as much as it used to, but enough to not be bothersome to me.

    I have tried physical therapy. I did that for six weeks with no improvement. My doctor xrayed it and he did not find anything wrong. He is totally baffled by this. He then did an MRI and found that I now have severe arthritis in the toe joint. He told me that in the future my options would include a toe fusion or joint replacement but I am only 26 and he would not perform either of those procedures on my at this point because of my age.

    I know having you toe bend down is not as important as bending up as far as walking goes, but it is uncomfortable. I often jam my toe when walking and I know it sounds stupid but having a heavy blanket on it is absolutely intolerable. It is also very difficult to wear flip flop type sandals or shoes that are not attached on the back of my heel. I am female BTW.

    The joint is completely stuck when I try to bend it down. I can't even bend it manually using my hand nor can I bend it using my foot. The joint on the very top bends but the joint where the bunion was fixed does not bend at all. It just sticks straight up in the air. It is also still very painful. The doctor felt that at this point I should not be having this much pain and swelling. He tried a cortisone shot which didn't do anything in my opinion.

    So I don't really know where to go from here. The doctor just wants me to continue with cortisone shots and "live with it" I suppose.

    Any reasons why it won't bend down? I feel that at this point my only option would be for the doctor to open it up again and take a look with anoher surgery unfortunately. I really don't want to go down that road again but this is really bothersome and I need it to be fixed totally. I work in a job that requires being on my feet for 8+ hours a day and I come home and a tremendous amount of pain. I did the surgery to alleviate the pain but I feel that that pain is now worse than what I had. I wouldn't have done the surgery if this was going to be the outcome.

    Should I push for the joint replacement? I like the idea of being able to get the joint fixed, have improved ROM, and most importantly, be pain free (hopefully). I realize I am young for that procedure but I don't see any other options at this point. I don't know if I would feel comfortable with a fusion... I still am, well... was fairly active before all this with my toe and I hope to be again one day.

    Thanks!
     
  2. FootDoc

    FootDoc New Member

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    ***************************************************
    As always, I am not able to address your individual case, but I can review potential scenarios which may or may not be germane to your situation. That being said, one thing in relation to your case which I feel needs comment is how it would be possible to fail to see "severe arthritis in the toe joint" on x-rays, only to have it detected on an MRI. That is NOT a logical eventuality, and I would advise that you discuss that with your doctor, as an assessment of the status of the great toe joint is a general requirement before a particular bunionectomy procedure can be decided upon.

    I don't know where your pain was prior to surgery, but in my opinion, if the pain was not simply from the effect of the shoe rubbing on the bunion bump, a procedure which does not address the etiology of the pain is required, and an Austin bunionectomy is unlikely to do that. Incidentally, an Austin bunionectomy is defined by the particular style of osteotomy at the head and neck of the first metatarsal, and a McBride bunionectomy or something similar to it is always performed along with the osteotomy.

    Now, to the possibilities. It would appear from what you have stated (the joint seems to stick up) that maybe the osteotomy cuts were made in such a fashion or the K-wire fixation was done such that it set the metatarsal head in a position dorsally out of line with the its shaft, or perhaps you bore weight on the foot and the K-Wire fixation was not firm enough. It could also be that the joint capsule was tightened too much and there is compression. But I am really taken aback by this late diagnosis of "severe arthritis." Your having not mentioned otherwise, I would assume that your toe move without difficulty or pain through a normal ROM prior to surgery, and that would certainly belie a situation of severe arthritis in the joint. So, there is just too much here that I cannot understand, and, as I stated, I am speaking only generically and speculatively. I think you have to get some unequivocal facts both in regard to your pre and post-operative condition from your doctor.
     
  3. Unregistered

    Unregistered Guest

    Thank you for the response.

    Before the surgery, I had a bunion obviously with the associated pain. It wasn't pain from my shoes rubbing on it so much... it was more of the joint pain. I had limited ROM before the surgery but in the other direction (as in the toe wouldn't bend up as far as it should have).

    Yes I thought it was odd too that I went from having no arthritis to severe arthritis. I was allowed to bear weight on my foot immediately post op using a boot and had the k wire removed at 4 weeks. There were no xrays taken before the k wire was removed though to see the healing progress. Once the k wire was removed, I was allowed to bear weight using a shoe as normal. Maybe I over did it and messed it up?

    After the k wire was removed I was never able to get the toe to bend down. It was stuck forever since then. The doctor claimed it would just take time... but it is stuck. It doesn't budge at all.

    I am waiting for approval on a second opinion from my insurance company. Hopefully I can get more information.
     
  4. FootDoc

    FootDoc New Member

    I think that's a good decision.
     
  5. Unregistered

    Unregistered Guest

    Hi
    I am having the same problem and in addition to the toe not bending downward, a painful callus has formed under the big toe. I was also given the cortisone shots twice which did nothing to help. I was told to jusy keep the callus filed down. This was unacceptable to me and i became very frustrated so i went to a different orthopaedic surgeon. They saw that a little hard bone was in my joint space preventing it to bend. This is a sesamoid bone believed to have shifted during the surgery. They offered to perform another surgery to remove the bone and also the staple that was used to hold my joint together after the surgery. I have not done it yet but at this point its worth a try. The arthritis story that you were giving sounds like they just didn't know what else to say. Go to a different doctor like a did.
    Hope this was helpful.
     
  6. Annoyedx10

    Annoyedx10 Guest

    Hello,
    I had my bunionectomy in June. I am suffering from the same stuck up toe problem. I have tried just about everything. Doctor says that there is scar tissue accumulated under foot..big toe. They said that in order to remove the scar tissue that I would have to have another surgery for that. I'm not looking forward to that as I got really sick from the anesthesia. What else can I do? I even bought a therapeutic ultrasound machine to see if that would work. I have only had it for a few days so idk yet about that.
    It is so frustrating because I do feel like I have a golf ball under my big toe and tend to walk on the side of my foot to alleviate the pain! HELP!!!
     
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