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Stiff toe after wedge resection

Discussion in 'Ask your questions here' started by jocelyne, Sep 3, 2011.

  1. jocelyne

    jocelyne New Member

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    Hello! I need some advice. I originally posted this a couple of weeks back, but unfortunately got no replies. I am trying this again, and have updated the timelines below. Thank you for any help or advice! :)

    Here is my background information (sorry in advance for all the info):

    -Hx of ingrown toe nails in both large toes, with reoccurring infections before 1999 (13 yrs old)
    -10 awful wedge resections (5 surgeries, 1 toe/2 sides of nail performed at each surgery), performed by GP in 2000 (14 yrs) – not my choice
    -4 successful partial wedge resections to alleviate infection, performed by podiatrist in 2009 (23 yrs)
    -1 successful wedge resection for 1 side with no infection, no re-growth, performed by podiatrist in 2009 (23 yrs)

    -Recent wedge resection for remaining 3 sides with no infection, performed by same podiatrist in 2011 (25 yrs):
    o Toe with only 1 wedge resection was as successful as the one done in 2009. Some clear fluid discharge.
    o Toe with 2 wedge resections wasn’t as successful and needed more injections than the other toe to keep numb. Side effects: loopy during surgery, infection (top of toe was dark red), had lots of discharge on one side, lots of swelling, and stiff toe. First round of antibiotics: Cephalexin 500mg. Second round of antibiotics: Clindamycin HCl 300mg. Infection is gone, but stiff toe remains. Extreme pain present at DIP joint when bending toe in (hence stiff toe), but no pain when bending toe back (towards myself). At 6 wks podiatrist performed ultra sound. Tendons/soft tissue fine. Originally he thought of sending me for x-ray, then bone scan. After consulting with colleague he agreed to wait another 3 wks (1 wk left; total of 9 wks). They believe it could be nerve damage from surgery and just needs time to heal.
    o Timeline: Surgery July 9th, 2011; Follow up and medications July 13th; Follow up July 29th; More medications August 9th; Follow up August 23rd. Now at 8 wks...

    I know I have given you lots of info, but here is more, as per your guideline from your website:
    o Where does it hurt? = DIP joint big right toe (stiff toe)
    o How long has it hurt for? = 8 weeks
    o How bad is the pain? = does not hurt unless I try to bend the toe in
    o What were you doing when it started? = pain started after wedge resection, could originally bend toe before surgery but not after tourniquet came off after surgery
    o What have you done for it so far? = soaking in salt water, polysporin, and antibiotics (Cephalexin 500mg and Clindamycin HCl 300mg) for the infection; ultrasound for the stiff toe
    o Anything relieve it? = not bending it
    o What have you been told about it so far? = possibly nerve damage from wedge resection
    o Is it affecting your ability to work/play sports? = recently stopped exercise except calisthenics
    o Do you have any other sort of symptoms? = I think this is unrelated – I have shooting pain in middle of same foot that started about 3 weeks ago (comes and goes), nausia
    o What country? = Canada
    o Additional: = Healthy, female, 25 yrs old

    My questions:
    o Can nerve damage be permanent?
    o Can stiff toe be permanent?
    o Is 9 weeks too long to wait before further investigation, or normal?
    o What else could be causing my stiff toe/pain?

    Thank you for taking the time to read my situation, it is very much appreciated.
  2. Unregistered

    Unregistered Guest

    Hi, do you know what your doctor used to destroy the nail bed? I just had a wedge resection done too, the doctor used a surgical cauterizer instead of acid to destroy the nail bed at the bone (he said this give it only a 10% chance of regrowing). Since then however on the left toe it hurts in the exact same place as yours (I had 4 resections 2 on each big toe). Also when i underwent my procedure both toes were not numbed after the original ring injection and the doctor had to use about 10 times the normal amount of local to keep them numb.

    I'm wondering if it was a combination of using so much local, and cauterizing the bone that may have caused some nerve damage in the toe?
  3. Anthony Short

    Anthony Short New Member

    I'm not sure if you have had 'true' 'sharp' wedge resections, or one of the many other variations of procedures that have been developed in the past 100 years for ingrown toenails. Did you have stitches in your toe? or was there a wound left to heal in?

    If there were stitches, then you have had one type of 'sharp' procedure. It could be the incision came close to the joint, and might have affected it in some way - though this would be very unusual.

    The most common complications following any nail surgery that your podiatrist will be considering, are;

    • infection (osteomyelitis)
    • delayed healing
    • post operative nerve pain (eg CRPS)
    • nail recurrence

    There are obviously other possibilities as well.

    I'm a little concerned that you are getting shooting pain in your foot. This might reflect a nerve pain condition like CRPS, that can sometimes (rarely) be triggered by minor surgery of this nature.

    I would normally expect 99% of people to be fully healed and in no pain by this point. Hope this helps, but I think you should be getting back for another check on your progress.
  4. FrankieBones

    FrankieBones New Member

    Not sure if eight weeks is the typical full healing time or not. It's been eight weeks for me and I'm experiencing some pain still. Looks like a bit of bruising in the oddest places on the big toes.

    The pain is in two forms: Possible nerve damage from three shots in each toe with lidocaine.
    The other pain feels like an ingrown toe nail. My doc said never to cut toe nails but to instead file them. I've been filing them with a cordless electric filer and the tip of the nail (near the side of the skin) is really sharp.

    I think I may have screwed up my healing about three or four days after procedure. The doc said I'd be good to go after a few days so I got on my treadmill for 10 to 15 minutes on slow with my sneakers on. I called him and he told me to wait another three days before getting on the treadmill. Sheesh!

    I wore open toe slippers for the longest time and soaked in epsom salts. I even cut holes in my socks to expose my big toes. By not wearing my orthotics, my plantar faciitis returned.

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