bunion toe pain 2 years after surgery0 HELP!?!
Yeah, I know. I work in healthcare. But seems I am reaching a dead end (or in denial about what course to take)
History: 2007 Pre-EN finally had surgery for bunion on R foot (it was bad, was told in 2000 to have it done and put it off for 7 years cause I am such a good patient). Anyway-healed up, returned to running, joined EN, completed iron race 9 months after surgery. Had no problems through all that. Had an occasional twinge, nothing that lasted. Fairly regular with foot massage.
In my rest from triathlon through the fall I have been doing DVDs that are a lot of core and plyo. For core think on the floor in plank position and doing all sorts of arm and leg moves.
Pain is at/over the surgical joint. Saw podiatrist that did the surgery, we already know I have arthritis in the joint. He compared x-rays and felt that I had no change and all looked good. I have iced, massaged, stretched. Have not taken NSAIDs. Cut running back to 1x/week even though running didn't really seem to aggravate the pain- or I ignore it and am no worse that I can tell. Cut out MOST of the jumping and tried to modify plank foot position to avoid being on toe end.
Pain persists a bit when I walk. Biking even seems to aggravate it, which is weird.
Only other change I made recently (just had an "AHA!"). I started wearing my orthotics in EVERYTHING including biking shoes, where previously had only worn them when running. Orthotics did not need replacing per podiatrist.
So is it the jumping? Or could it be the switch to always wearing the orthotics?
Comments
I reccomend you try glucosamine (sp), I hear it helps lube the joint but as far as growing new cartilage is unknown. It has helped 3-4 athletes that i know and trust, give it a try. In most cases i know it takes about a month to really start kicking in.
I just had bunion, neuroma and cartiladge in the big toe worked on the day before thanksgiving. I am recovering now and I am bowing out of the EN scene for a 3 month hiatus for complete recovery. My surgery went well, just about pain free. I am iceing alot and working out in the gym doing core work ,recumbant bike cycling, and some swimming. I will come back to EN in April to start retrainingl.
My races this year will be Patriot again an maybe RI Half. I look fwd to seeing you at patriot and will give you surgery update there. Good luck with your toe, I wish i could tell you something to help but you are ahead of me in this venture. I will be standing in line for IMLP 2011this summer as well and looking for the honey vendor on the bike route I missed in 09.
MIkeN
My guess is that it was a combination of stuff that led to the flare up. Plyo's can be surprisingly rough on your lower leg muscles, especially your calves. Adding that in with OS stuff and stack orthotics on top of it and you can really be loading up that toe without even trying to.
Good idea to tone down the plyo/plank stuff. I would maintain that until your at least pain free while walking.
In the mean time- foam roll and dig your calf out like crazy- gastroc, soleus and post tib. I'd even throw in your ant tib (along the shin) and peroneal (outside of leg knee to ankle bone). trigger point your arch.
The problem with adding the orthotics to your bike shoes is that it purposefully changes the pressure points in your foot. If you don't adjust your cleats accordingly, you start to lose the ability to push down full force on the pedal due to limited ankle motion. Once you push off, you reflexively relax your calf and ankle joint. If you don't fully push off, then you compensate by pulling your toes up and using your shin muscle. Normally not a big deal, but in bike shoes pulling your big toe up grinds that joint into a very stiff sole that you then pound back down on the pedal. There's just no rest for it- especially in an OS type workout. It's a big reason why people end up with sesamoid problems, etc.
A temporary fix is to slide the cleats back some. Match that with a drop in saddle height. Will help unload the calf and take pressure off of the big toe. If you still have pain, might be worth a visit to your bike fitter. He'll be able to see how else the foot is moving while you pedal and work on the rotation component etc.
Hope that helps.
Thanks Leigh!
I hadn't thought about the calf being part of this even though I always need to stretch and roll it. I've already cut the orthotics back to just running again and the pain is less. The liners in my bike shoes were original and worn out, so I replaced those with ones that are heat molded to the foot. Will see how these changes help. Much appreciate the advice.
Caveats: I am not a podiatrist nor a PA; just an humble OB MD. But I did have bunion repair in Nov 06, and recall some teaching my podiatrist gave me before the surgery. Two points:
1. Agree that there is no need for orthotics in a good bike shoe with cleat well back from the front of the foot.
2. Pain MAY be due to nerve pressure; podiatrist explained to me that my pain pre-surgery was due to that nerve which runs just over the top of the joint was being impinged by the distorted bones. (That plus cleat in wrong place led to numb toes for months after I biked 3500 miles in 60 days in 97).
So anything to relieve pressure and swelling around that nerve may help, including ice after use and the other suggestions above.
Thanks Al.
Question- while doc was removing sutures post-op, one broke. I have not had any problems. Just noticed that it is now visible and has migrated about 5mm medial and the tip is close to the skin surface. This is a very new event as I routinely massage the foot and have paresthesias. It was not there 3-4 weeks ago when I had a check-up. Could this also be part of it?
Wow! So this is from surgery 2 years ago? It must be a monofilament nylon suture to still be there. While it is "inert" and should cause no harm, it may be that as it migrated through to the surface it caused some inflammation or even granulation tissue formation, irritating nerves along its path. What I would do (if it were my foot) is grab it, pull it out like a splinter, but then I'd have only myself to blame if something went wrong. If I tugged gently and it didn't come, then I'd have the doc do it. Could the knot still be below the surface, or was the knot removed at the time of suture removal when it "broke"?
No knot. I watched him cut it before pulling. The proximal end came out with difficulty, the distal end was the one that broke. It is a nylon monofilament. I was really surprised when I noticed it the other day. When I can feel the tip, I will pull it out. For now, I cut the orthotics back to running only and put the new inserts in bike shoes. Less pain already and numbness after biking today was due to extreme cold while the duct tape was coming off my shoe. Thanks so much.
not uncommon for sutures to surface several months and even years later. takes the body a long time to push them to the surface once it rejects them. see it in knee's all the time. a year later and all the sudden people have fishing line poking through one end of their surgical scar. I agree though. want to see a pic!
OK- For those that have the "pics or it didn't happen" view.
1st- my nicely pedicured foot. Don't know why that toenail is blue in the pic, it is actually same polish as all others. Note scar, can't see emerging suture.
Next is a side view. The black area to the left of the scar is the emerging suture.
Although we did video the actual removal (because I thought this would hurt and I would be screaming) it was actually painless. But I am surprised by how long that thing actually was!
I can honestly say that my toe has been feeling better with all of the changes. I stopped full time orthotics, stopped plyo exercises (mostly, not completely) and then removing this actually seems to have helped. I don't think it has been a problem for the past 2 years. But for what ever reason that it began to migrate, I think it was irritating the nerves because my paresthesias were affected. I still have them, but am hoping they will diminish.
Thanks All!
Wow, that is long!
Nice nail polish and toe ring. Your foot got dressed up for the picture
. Hope it feels even better soon
Tracy- Yeah, I was glad that I'd had a pedi the week before. I am going to try and be good to my feet this OS and get a pedi every few weeks. I get lazy if I leave it to do myself.
First - that's one good lookin' foot!
Second - I couldn't get away with the pink toenails, but I almost always have one or more that bluish color.
Third - good teaching case for me as a surgeon about where to cut the skin sutures - never right at the skin surface, so you always have a second chance to pull it out.
Nerves take a while to recover even from a minor tickling - might be weeks before parasthesias disappear.
WOW! hands down, you now have top honors in my book for longest P.O.S.E. (post-op suture "emergence").
@Al- Thank you. A pedicure definitely makes feet prettier. I try not to get blue toenails.
@Leigh- That is not an award I would have aimed for, but Thanks