Mid foot pain following bunion surgery?

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hello all, i am a new member and this is my first post so be kind!

i am a GP with an orthopedic interest. i have had a couple of patients experience chronic mid foot stiffness following bunion surgery. both are now more than 12 months since surgery. both had bilateral surgery but current problems are unilateral. they describe stiffness, worse in the morning. it eases somewhat through the day but towards the end of the day, after time on their feet the stiffness becomes debilitating once more. there is minimal arthritic changes and neither have an inflammatory arthropathy.

i as wondering therefore, if someone has lived with bunions for many years with presumably gradually compensating foot mechanics but then has bunion surgery, would the new anatomy alter the foot mechanics to explain this stiffness?

i am assuming the stiffness is more from soft tissue tightness/tendinopathy rather than bone inflammation given the normal XR.

orthoses are currently being used for medial arch support with some relief.

are there other therapeutic measures? cycling would seem the obvious self-help to improve flexibility and relieve the stiffness.

James

 

James:

Welcome to Podiatry Arena.:welcome:

You may consider the diagnosis of Dorsal Midfoot Interosseous Compression Syndrome (DMICS). DMICS may occur after bunion surgery due to transfer of ground reaction force from the first to the second and third metatarsal rays due to the shortening of the first metatarsal that typically occurs with most bunion surgeries.

Here is some reading for you to see if DMICS fits the diagnostic picture of your patients. Good luck and Happy Holidays!

 

Hi James

Weight transfer to the 2nd/3rd met can certainly cause midfoot pain, usually with sub 2nd/3rd met head pain as well.

However, low grade pain, "stiffness," in the midfoot is a common early symptom of intermetatarsal neuroma, which is common in a bunion foot type.

Something else to consider.

Cheers

 

Hi James
Both the above are worth considering.
I can only add, and I guess I have a bias here, that a series of soft tissue and joint mobilisations of the foot and ankle may well be under utilised as part of post surgery rehab treatment.