Bunion Surgery Problems: Email Advice

Dr. Blake,

     I am one and a half year post bunion surgery of my right foot, and am having a very difficult time.  As soon as I was able to walk after surgery, I felt a tiny rub on the bottom of the foot, but just assumed it's normal after surgery, six month after, resumed normal activities, doing Zumba, Spinning, hiking, which may have contributed to the problem I am having now.  There was always a tingle, an ache, big toe area always stiff and frozen. I mentioned it at checkups, but the surgeon didn't seem to be concerned about it.

Dr Blake's comment: I am not sure if I would have told you anything different at this stage as long as your function seemed fine. Post surgery, bunion or any other surgery, surgeons expect 20% of the symptoms to just gradually work themselves out, as long as the pain level stays between 0-2. This is how you are presenting this at least. 

     Begining of June (6 weeks from the day of this email), the foot started feeling numb, and shooting pain along the big toe area. 

Dr Blake's comment: Now you are having nerve pain and this is quite disabling. Surgical joints are always the weakest link in the chain. They are the one most picked on. The present day does not have to have anything to do with the surgery, other than that this area is a weak spot for you. 

     Went to the Dr, ordered custom orthotics, not even x-ray, endured stabbing pain, was told to adjust the orthotics, still waiting for the appointment to see him.

Dr Blake's comment: So, what should of happened then and now? Creating a pain free environment needs to be accomplished with shoes, orthotics, removable boot, crutches, etc, and anti-inflammatory measures (minimum of 3 times daily 10 minute ice pack). During this time, the sometimes slow process of figuring out what is wrong with diagnostic injections, xrays, nerve conduction tests, low back evaluations, etc should be started. 

     I went to another surgeon, who took the time to watch me walk, x-rays, and said I have sesamoiditis. Pain and discomfort is nonstop, I can barely walk... my question is, what is the relation between bunion and sesamoiditis?

Dr Blake's comment: Your big toe joint, which was remolded to remove a bunion, has 2 bones called sesamoids under neath. You big toe joint is a weak link in your bio mechanics. There are so many scenarios of what is happening to you I could write a book chapter at least. The most obvious, because this is a fairly common problem, is that the bunion joint following surgery is continuing to get weaker. Perhaps some arthritic changes are occurring in the joint which is very common. Perhaps the surgery weakened that side of your foot enough that you are pronating more now and overloading the sesamoids. If there was a surgical complication, you would have been in pain a year ago as you went into normal activities. Perhaps this has nothing to do with the surgery (very common), and it just a new injury due to your activities. The reason you got the bunion is that your mechanics are weak in that area, and unless the surgeon did bone fusions to stabilize (highly unlikely), you are still weak there and could have just irritated the sesamoids.

The fact that something is rubbing right after surgery made me feel something went wrong with the surgery, but the second surgeon I saw said the surgery was fine from what he saw in the x-ray. I never felt the foot went back to normal, and now, I cannot even handle daily routines.

Dr Blake's comment: We tell our patients who have bunion surgery that we are not giving them a normal joint. But, we can hope we are giving them a better joint. You may indeed have a surgical complication that can not be seen on xray. Even seemingly minor collections of scar tissue in the wrong place, can give symptoms. My best guess, based on what you have told me, is that you have a predictably weaker big toe joint area that is susceptible to injury. I can not presently tie it to a problem with your surgery, so my recommendation is to work with the PT on creating that pain free environment, treat inflammation when found, definitely treat the part of your pain that is nerve related with treatments that help that. Get an MRI or neurological workup for possible nerve entrapment, or a diagnostic injection series to find out exactly what structure is painful. As you progress through those steps, you should predictably feel better and better. I hope this helps you some. Rich

Your blog is the best information I can find online, and I just don't know what to do. The new Dr. did send me to Physical Therapy.

Thank you so much for your time, I do hope to find answers from you.