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“.
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:
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.
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.
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.
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.
|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.
It is likely to provide the best pain relief, second only to a custom orthotic.
||2. 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.|
||3. 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.|
|4. 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.|
|5. 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.|
|6. In smaller shoes, such as women’s dress shoes, use a Gel Metatarsal Pad.|
||7. 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.|
Remember, your primary goal in treating this problem is to get the pressure off of the ball of your foot. To accomplish this:
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.
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.
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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