Question
I fractured my left big toe during a scuffle and receive workman's comp. I have been treated by my orthopaedic doctor for over 6 months and have tried everything that has been recommended. I was placed on crutches and a rocker (medical boot), used pain pills, Voltaren gel, did exercises (up and down) to increase ROM, wore hard sole boots such as Bates to get used to wearing shoes all over again, received a cortisone shot... and now I'm about to start wearing arch supports (I don't know which type) to help support my foot.

Although I don't know for a fact if the bone has healed because I haven't had another Xray in about 4 months, I still continue to have serious pain that doesn't allow me to wear any other shoes except boots and my rocker (which I still wear almost all the time). The pain I feel is primarily on the side of my toe where a bunion can occur, but I also feel pain on the front of my foot near the big toe, in between my toes, and on the sole of my foot where the big toe and the foot bones meet. The pain is intense whenever I bear weight on my toe by attempting to walk in soft soled shoes, stand on my tip toes, run, or jump. I also still feel pain after I've worn my Bates boots for 5 or more hours and I have to transfer to wearing the rocker. I believe the bone has healed because I am able to walk better on a hard surfaced floor without any shoes, but I'm still not sure if it's healed.

I regained ROM in my toe, but my doctor has been telling me that surgery is more than likely the next step I need to take (fushion of the toe bone), but I really don't want to have surgery. My doctor wants me to get a second opinion from another doctor (foot surgeon) to see if there's anything else that can be done. Actually my doctor has been mentioning surgery as a possible option since I came to him because he made me aware that it's one of the worse big toe injuries he's seen and that I more than likely will have permanent damage of some sort even after it's "healed". I have considered surgery, but I really don't want it. My questions are:

(1) Are there any other treatments that may benefit me besides what I have mentioned?

(2) Should I have the surgery to fuse my big toe bone because of the pain? I'm very afraid that I'll never be able to run, jump, or play strenuous outdoor activities if my toe bone is fused.

(3) How is the arch support going to possibly help me?

Answer
Hi Toy

(1) Are there any other treatments that may benefit me besides what I have mentioned?  If the fracture is not healed you may benefit from a bone stimulator.

(2) Should I have the surgery to fuse my big toe bone because of the pain? I'm very afraid that I'll never be able to run, jump, or play strenuous outdoor activities if my toe bone is fused.
I can't answer whether you should have the fusion as I have not seen the fracture.  However, in cases where there is major joint destruction and ongoing pain, fusion is an option.  After a fusion, most people can return to normal activity.

(3) How is the arch support going to possibly help me? Arch supports will align you foot properly so that you are distributing your weight through the foot.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
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