The above letter was received in January 2002. My
comments are written in italics.
Dear Doctor
I have viewed the pictures relating to the bunion operations and wish my
82 year old mother did not have to suffer the way she is suffering now, after a bungled
bunion operation that was carried out about four years ago here in the UK.
The pin that was put in the right toe to straighten it (As
I stated in my monograph pins, also called K-Wires, can be used to hold the
bones in place after a bunion surgery. The hazard with these pins is twofold:
they can get infected and they can break. Since they are protruding from the
skin they can be a source of a foot infection during the two to six weeks they
are in place. And since they are only the thickness of a thin shirt hanger wire
they are subject to breaking if bent too much. This seems to be what happened to
your mom. When they break off they can sometimes be retrieved, This might take a
second surgery. If they are entirely embedded in the bone they can be safely
left alone. If the end of the wire rubs the bone, however, arthritis is a likely
result. This might have happened to your mother. I avoid using any wires that
stick out of the skin at the time of bunion surgery.) (both feet were
operated on at the same time) (Also I avoid doing both feet a the same time
whenever feasible. When both feet have been operated on there is no "good
foot" to stand on.) broke off during removal after the operation
and was left there for over two years, despite her complaints about pain
and there being visual swelling under the sole of her right foot and
tenderness, during this time she was also given injections in the toe for what
was described as a trapped nerve whilst the pin still remained. But an eventual
operation proved the pin was still left in the toe. (This
should have been easily detected with an x-ray).
Since then the sole part underneath the left big toe continues to be very
tender and painful, there is sometimes swelling of the ankle and sharp
stabbing pains along the foot area and also her back because of the
imbalance in her posture. She now walks by the aid of a walking stick but tend
not to use it at home only when she goes out. (Do you
know if the x-ray shows that the pin in in the joint between the toe and the
foot i.e. the first metatarsophalangeal joint?)
Is there any treatment to assist what she has been told is a damaged nerve in
the toe, apart from undergoing another operation to perhaps have the nerve
removed, although I do not feel this is advisable at her age? (Obviously
this is impossible for met to say as I cannot see or examine the foot. If you
ruled out the pin involvement with the bone, then the possibility of a nerve
involvement is more likely).
Unfortunately, there is not much cooperation in putting this damage right and
her suffering concerns me immensely. I would be so grateful for any advice
you are able to give and I appreciate without carrying out an examination
personally, it is difficult to give a diagnosis, but the symptoms are as I have
described them above. (Monica,
I am sorry I am not of much help. Perhaps a second opinion with a different
surgeon would help you. If the pain is due to the damage caused by a retained
pin in the wrong location, then it is unfortunately too late. If the pain is a
trapped nerve, then perhaps a surgery would help. But first try a few cortisone
injections. And there is even the possibility that a series of sclerosing
injections for the nerve pain would help. See my page on sclerosing. I am sorry
about your mom's pain. I wish there was something I could do.)
Yours most grateful.
Monica F.
