Question
Hi Dr. Katz.  Thank you in advance for your time. About 18 years ago I went to a Podiatrist for a bone bump on the top of my foot...diagnosed as a first metatarsal cuneiform spur.  The Doc gave me the option to have is shaved down or to take more conservative measures.  I chose the latter.  I went through heel lifts, ultra sound treatments, physical therapy and 3 years of cortizone shots.  The Heel lifts hurt too much so I stopped using those after 3 years .  I received the shots because I was experiencing too much pain from the heel lifts. Once I stopped the heel lifts, I also stopped the shots.  Over the past years I have been suffering from pain at the top of this bump down to my to my big toe.  It is a burning stinging type of pain, and often sharp ice pick type pains when I'm not moving it at all.  I recently went to a new Podiatrist and the x-rays revealed that I had a complete fusion on the bottom of this first metatarsal cuneiform joint...no joint was left, and a partial fusion on the top.  The Doc said that it looked like I had crushed it at one point.  The bottom of this met-cuneiform joint is actually bulging out to the side of my foot from extra bone overgrowth.  Is this a bunion?  I am a female...42 years old...I weigh 113 pounds and am very active.  In between this time from the first diagnosis 18 years ago till now, I have climbed many stairs...have done about 500 jumping jacks a day...ran many miles...all to stay in shape.  My Doc referred me out to another Podiatrist that I will not yet been able to meet with until next week.  He said the best option would be a fusion surgery.  What kind of surgery would this be? and how would it be done?  He also noticed the the bones on  the fist metatarsal phalangial joint are also touching on the outside corner.  Is this beginning to fuse also? What should I expect from my next appt., and what types of questions should I be asking?  Thank you again for what ever answers you can give.  I do have a minor bleeding disorder with factor 8.  My readings are at about a 77. Other than that, I have no other medical problems.  I take only multi-vitamins and Tylenol to cut the pain. I can no longer take Advil because of the bleeding disorder.  Thank you and take care, Yvonne  

Answer
Hi Yvonne,

There are several steps before considering a fusion only based on an x-ray.  You would benefit from an MRI or CT scan to understand the full extent of the problem.  I would consider a pair of orthotic devices to support your foot better.  The pain and stinging is resulting from damage or compression of a foot nerve called the deep peroneal nerve.  This nerve courses near the 1st met-cuneiform joint and supplies the large toe and second toe.  You have a classic case of nerve compression and pain.  In my practice, I successfully treat this condition with a minimally invasive procedure known as cryosurgery or neuroablation.  This will kill the nerve causing your pain and works well in combination with the orthotic.

A fusion is an invasive surgery that involves removing a joint and joining two bones together to stop the motion.  I would only consider this as a last option.

See this site for the cryosurgery:
www.tampacryosurgery.com

Good Luck


Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.thetampapodiatrist.com
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://painfoot.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com

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