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I have few pt that complain forefoot metatarsalgia like pain under metatarsal head anywhere b/w 1-3 s/p bunion sx with either with proximal or distal procedure anywhere 3months- few yrs post-op. I usually tx them with custom inserts once swelling had decreased and issue forefoot gel cushion with padding plantarly. I also recommend new/wider shoes and give out Nsaids. Orded MRI which r/o other causes of pain. I also know some time this pain can be due to fixation techniques that lead to dorsiflexion/plantarflexion, angulation or screw placements in 1st ray the lead to tranfer lesion. However, I find the xray to be near anatomic and clinical exam was unremarkable. I check for metatarsal parabola ie. long 2nd met vs short 1st ray and equinus to r/o etiology for forefoot pain. question is do you do redo this bunion sx if they dont have any bunion pain symptoms? I usually wait 6 months for any redo sx. If so, what would you do? What am I missing? any help would help. Thanks

 

What does the bolded part mean?

 

I'm sorry. typing to fast. omit that part. should be just s/p bunion sx

 

No taker to answer this problem? There should be a good book on revision sugeries with foot and ankle.

 

Can you re-state your question? I still can't decipher where exactly the patient's pain is based on your original post.

 

pain at distal portion of metatarsal head region. 1st metatarsal to 3rd Metatarsal.