Hi Dr. J!


I had a v-cut bunionectomy in Nov 2007 on my right foot. After the surgery, I did extensive physical therapy for 6 weeks but still had limited ROM, so the doctors determined that my screw needed to come out to regain some of that range in March 2008. More physical therapy after the screw removal for 3x/week for 3 more months--still to no avail. I continue to have stiffness in my big toe (I can't bend it at all), SLIGHT swelling between my big toe and the next toe, and a constant burning/soreness around the base of the big toe joint stretching around to the ball of my foot, mainly around the sesamoid area. I still can't fit my foot into anything other than a flat shoe without pain. In addition, I have been shifting all of my weight to the right part of my foot, so now I have lots of soreness around the base of my pinky toe.

Here's the fun part! After this, my THIRD opinion, my doctor ordered an MRI of the foot, and has discovered that after a year and a half, the v-cut of the osteotomy is as clear as day and apparently not healed!

If this really is the case, and this is a malunion or non union of the original cut in the bone from 2007, what is usually done in situations like these? Is this a normally occuring condition? Can bone stimulators be successful on fractures like these? I also used a bone stimulator after the second surgery 2x/day for 20 min for 2 months, but apparently it didn't work I've heard some things about bone grafting...I am hoping that, if necessary, that is not an invasive procedure and that the post-op care isn't extensive and will keep me off of my feet. Does it involve a cast?

Sorry for all of the questions--I just feel like I've been thrown for a loop here!! Any thoughts you have would be great!

Thanks so much!
K

A failure of a bone to repair after nearly 2 years is a serious issue. You need to have a physical done by your primary care doctor, with complete blood work. Failure of a bone to regenerate can be a sign of a more serious problem--such as severe vitamin deficiency (if you are deficient in calcium for example, your body won't spare any for bone repair; it will horde it to regulate heart beat and support the 00..cardiovascular system. If you get an all clear from your primary care doctor, then I would consider consulting an orthopedic doctor as well as your podiatrist together before making a decision. The Ortho may have some good advice on stabilizing the bone.

Hi K,

Unfortunately, even with the best techniques and intentions, non-unions are going to happen. They're no all that common, but do happen.

Each of your suggestions are valid. I've tended to find that when you reach that 12 month point, you need to turn up the treatment a couple of notches to get it to heal. Casting? Maybe that'd work, but that would have been more effective in the first 6 months. Bone stim unit? Sure, that'd be reasonable and could be used in conjunction with any of the other treatment options you might choose.

With most non-unions your body have all of the healing potential it needs to get the nonunion healed, it just needs some help getting there. One fairly simple method of jump starting the healing process would be to use 1-3 growth factor injections. Take a peek on Google for something called PRP or platelet rich plasma. The technique of using PRP involves taking 50-60 ml of your blood, spinning it down and separating the growth factor. The growth factor is then infused around the nonunion with an injection. So barely invasive but still using your body's potential to heal. And then couple that with a NWB cast and the bone stim unit.

The real definative way to nail it would be with a bone marrow graft. I harvest bone marrow from either the heel bone or tibia and place it into the nonunion through small drill holes. Obviously, a bit of surgery again. And this would also be coupled with a NWB cast and bone stim unit.

Roxanne has a point regarding general health status. Up your Vit C and eat a well balanced diet. But even in light of good diet and general health status, non-unions do occur.

Jeff