Ball of Foot Pain After Bunion Surgery

Cures for Ball of Foot Pain After Bunion Surgery

The most common complication we see for patients who have had bunion surgery (either recently or years past) is pain under the 2nd metatarsal head.  Sometimes there is a callus present here and sometimes not.  Regardless of the presence of a callus, pain in this area is extremely common after having bunion surgery.

If you have pain at the bunion surgery site in the months after bunion surgery (in the big toe joint region) then read this article on “pain in the big toe joint after bunion surgery“.

Video: Pain in the Ball of the Foot After Bunion Surgery

Why Does the Ball of the Foot Often Hurt After Bunion Surgery?

The reason for this is quite simple.  When performing a bunion surgery, the first metatarsal bone is usually cut in order to realign it.  Whenever bone is cut it will usually end up healing slightly shorter than it was before the surgery.  When the first metatarsal bone is cut, the following happens:

• A shorter first metatarsal bone bears less weight and pressure

• With the first metatarsal bearing less weight, the 2nd metatarsal must bear additional pressure and weight

• The extra pressure causes pain and inflammation of the 2nd metatarsal head.

So it is very common that those who have bunion surgery will develop 2nd metatarsal pain at some point.  What we find frustrating is that many bunion surgeons don’t prepare their patients for this ahead of time.

How to Treat Ball of Foot Pain Following Bunionectomy

Luckily this is a problem that almost always responds quickly to conservative treatment.   Since the problem is too much pressure on the 2nd metatarsal head, the solution is to reduce this pressure.  There are several ways to reduce pressure on the metatarsal.

Custom Orthotics to Transfer Pressure off of the Ball of the Foot

The most effective method is to use a custom orthotic that conforms extremely close to the arch of the foot.  This type of orthotic, called a “total contact orthotic” has been shown in multiple studies to be the most effective method to reduce pressure under the ball of the foot (list of articles available on this page).

I had a patient in the office today who had this problem.  She was already wearing orthotics made by her chiropractor. Unfortunately, as we see all too often, the orthotics did not come close to conforming tothe arch of her foot and thus did not transfer pressure off of the ball of her foot. This is one more reason why, if you are going to get custom orthotics, get them only from a practitioner who specializes in the foot and in orthotic therapy.

Home Treatment of Ball of Foot Pain After Bunion Surgery

If you want to try home treatment for your ball of foot pain first, follow the 8 steps below. Try them for 3 weeks. First, however, here’s an important disclosure about the products recommended in this article. If you don’t have relief within a couple weeks be sure to see your foot surgeon or get an opinion from another podiatrist.

FootChair Adjustable Arch Orthotic	1. Use an arch support to transfer force off of the ball of the foot. This is the most critical part of the treatment. You should wear a firm arch support at all times for at least 4 weeks. We recommend the FootChair Podiatrist Designed Orthotic with adjustable arch height.  The FootChair Adjustable Arch Orthotic has the most impressive arch we have seen on a prefabricated orthotic as it has pads that can be inserted in a pocket under the cover to increase the arch height.  This orthotic is designed for full size lace-up shoes. It is likely to provide the best pain relief, second only to a custom orthotic. 2. For smaller shoes including high heels, flats and soccer cleats we recommend the FootChair Slim Orthotic. The FootChair Slim has the same exceptional adjustable arch as the full size FootChair above, but with a much slimmer profile that is designed to fit even in very small shoes such as high heels. We also like that it flexes in the heel to adapt to many different heel heights.
	3. When in the house wear a slipper or sandal with a built-in arch support. These will transfer pressure off of the ball of the foot. We highly recommend the Vionic Sandals and Slippers. Vionic has exceptional arch support and we recommend them to all of our patients with ball of foot pain.
	4. Wear socks with extra cushion under the ball of the foot. A sock with extra cushion acts to slow the velocity of the foot as it hits the ground and by doing so reduces force.  Make sure the sock is an acrylic material. Cotton is a poor choice for people with ball of foot pain because of poor cushioning. Our most recommended sock for ball of foot pain are any of the Thorlo Thick Cushion socks.
	5. Use a gel pad to cushion the balls of your feet. Two that work very well are the Silipos Metatarsal Gel Strap and the Silipos SoftSock. Both of these devices provide a tremendous amount of cushioning.
	6. Wear rocker soled shoes. Shoes with a rigid rocker sole can dramatically decrease pressure under the ball of the foot. Our favorite running and walking shoe with a rocker sole is Hoka One One. You can find other types of rocker soled shoes including dress shoes, boots and sandals in our complete list of recommended rocker soled shoes. On the same page you will find our guide to many more rocker bottom shoes and a complete guide to rocker shoes here.
	7. In smaller shoes, such as women’s dress shoes, use a Gel Metatarsal Pad.
	8. Ice the painful area of your foot twice per evening for 10 minutes each time. If you want a cold pack that is easy to keep on the foot we recommend the Bodyprox Foot Cold and Hot Wrap.
	8.  Use a topical pain reliever such as BioFreeze Cold Therapy Relief during the day. This is the least important of the treatments listed. It can provide temporary relief but it does not contribute to overall healing.

Our Best Advice: Don’t Go Barefoot and Always Wear Arch Support

Remember, your primary goal in treating this problem is to get the pressure off of the ball of your foot. To accomplish this:

• Don’t go barefoot at all – even in the house
• Wear shoes with a recommended arch support like the PowerStep ProTech at all times when you are on your feet.
• If you cannot wear shoes then wear arch support slippers or sandals.

Bee very consistent with the treatments listed above for best results. Most important is to wear arch support at all times when you are bearing weight for at least 4 weeks. If you are still not better, see your podiatrist.

Help Avoid Post Bunion Surgery Pain by Asking About Orthotics Before Surgery

If you are considering bunion surgery, before surgery ask your surgeon about orthotics after surgery.   If they do not understand the benefits of orthotics post-surgery, then you may want to consider a different surgeon or get an opinion from a podiatrist who specializes in biomechanics and orthotic therapy.

Contact Us for an Opinion

If you have already had bunion surgery and have pain under the ball of the foot, then see a podiatrist who specializes in orthotic therapy.  In the Seattle area you can make an appointment for an evaluation in our office.

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Doctors Hale and Huppin

Specialist in pediatric and adult foot and ankle disorders at Foot and Ankle Center of Washington

Skilled foot and ankle physicians with advanced education, training, respected credentials and more than two decades of meaningful experience in their chosen field. They are known for their excellence and are well respected by both patients and the medical community. They are authorities on orthotics, surgery and all aspects of foot care and diagnosis from routine matters to the most complex. They rely on evidenced base medicine for the best results.

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