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Sunday, February 3, 2013

Big Toe Joint Fusion: Email Advice



Hello Dr. Blake,
     I am in my 8th week of recovery from a fusion of my great toe and struggling with pain that I am not sure is related to the original injury or surgery.


2 Slightly Different Views of the Same Right Big Toe 


     Pain occurs mostly on the bottom ball and feels like fire when walking.When my foot is extended (especially when laying in bed) the pain runs along the arch and then to the outside of my calf causing it to fall asleep.   Dr Blake's comment: definitely nerve pain with nerve tension.

     Doctor hit it with cortisone and it is not helping. Dr Blake's comment: nerve pain may and may not respond to cortisone, since it only helps the inflammation involved. 

 My doctor is great...it is just that I will not be able to see him until end of week and I wanted another eye on the x-ray. I have attached photo of x-ray from the 2nd week after surgery as that is all I have with me. Does this sound like sesamoid trauma and is that something I should have my doctor explore? Do you see any indication in the x-ray? Thanks for the blog and for responding with any advice.

Dr Blake's comment: most likely the nerves that run under the fusion area that extend under the ball of the foot and into the arch and then up the leg are irritated. Why they are irritated is what needs to be investigated. The fibular sesamoid looks irregular, but that may or may not be something. The Hallux (Big Toe) looks like it was broken as part of the procedure, so is it stable yet? If not, the healing fracture or healing fusion may be producing enough swelling that the nerves in the area are being stressed. A CT scan may be necessary to analyze the bone healing. Delayed healing of fusions is very common and just needs more time to immobilize. 
     Treat the nerve pain with your own relative rest, icing of the area, crutches if needed, etc. Since you do not want the nerve pain to get out of control, and before you know what is going on, create the pain free environment as best as possible. Sure hope this helps you. Rich Blake


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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.