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Thursday, January 14, 2021

Big Toe Non Union of a Fracture: Email Advice

Hello Dr. Blake, 

I broke my big toe 6 months ago by 1st proximal phalanx. 

It wasn’t too painful. While it was ‘healing’ I developed pain under my big toe which I thought was pain from the break. It turns out I developed sesamoiditis. 

Also my toe is now a healed nonunion. I have been significantly impacted with pain most of the time. Walking even short distances was almost impossible for a while. 

Even now it almost always hurts some to walk at all. I had a boot for 2 weeks at 3.5 months. I am getting PT which seems to help with general pain in toes but not pain on bottom of foot. 

I was able to snowshoe on soft snow but hard ground is painful. I can swim with some pain and can’t push off wall with that foot. Biking hurts some. MRI showed no fracture or inflammation of sesamoids which presumably means tendinitis or capsulitis.

 I have arthritis which I had before break but it wasn’t painful. MRI 3 months ago shows inflammation under 1st metatarsal area. Tight shoes make pain worse even if soft. Touching spot on bottom of foot with shoes or ground hurts.  I am also now getting similar but less pain in other foot. I have a bone stimulator for toe now. 

Is it possible to get better? Is cortisone a bad idea? If it hurts so badly wouldn’t that mean the bones are sore? Is there any treatment for tendons if that is it? Do ultrasound or other treatments work? What should I ask my doctor at this point?

Thanks for ideas.

Dr. Blake's comment:

     So sorry to hear! A non union of the big toe typically requires surgery! Has this been offered? The bone stim is great but the toe has to be completely immobilized for 3-6 months while the bone is trying to heal! Typically any tendinitis or sesamoiditis is secondary to abnormal gait from the nonunion. So, do the best to heal the non-union or have the non-union surgically pinned. Hope this helps and I hope I understood the situation adequately. And, cortisone could help the joint capsulitis, but not good for bones trying to heal. Rich

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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.