Hi guys, I went for my 6weeks post op today and after doing an x-ray surgeon told me the bone isn't showing…

oh my goodness, this sounds rather scary to know that such happens. May I ask, is/was your foot in a cast the whole time? Are you still in a surgical shoe?

this bone takes a long time to heal. I would not be worried yet. I suggest more time, takes 4+ months, often a year or more

I was bandaged and in a post operative sandal, no cast. Rest with feet elevated for two weeks. No driving for seven weeks thereafter (nine weeks in total without driving). I blindly followed my orthopaedic surgeon’s advice in the hope it would heal but it hasn’t. I since understand that it’s unlikely to occur after three months if it hasn’t already. I regret not getting a second opinion earlier, back in September when it was apparent it wasn’t healing optimally. I’m in pain still and have very limited footwear.

This was 1 September (ie four months post operation). I blindly followed the orthopaedic surgeon’s advice until 23 November when he next saw me and he advised I’d need further surgery. I have lost faith in him and I’ve since went to a sports specialist surgeon who has recommended another orthopaedic surgeon whom I’m awaiting my first appointment later this month.

it’s been over 8 months. Every medical professional that has seen it has stated it needs correction.

how is your pain? I see many patients like this that end up healing without intervention. I have done about 500 5th met osteotomies in this fashion. At 8 months, I think it may be worth it to hang on a little longer, as an intervention would likely require 4+ months longer, bone graft, plate and screws, bone stimulator. What is your activity level? How is your vitamin D levels?

all my levels are fine. CT scan is showing mild medial displacement of the distal fragment by 3mm, along with mild plantar displacement. The fragments are separated by up to 3mm with no osseous bridging. The margins are well corticated. How long would you suggest waiting?

how is your pain? If symptomatic - may consider intervention. If not painful, I would wait.

constant but tolerated. I can’t wear shoes that press against the top and outside edge.

the orthopaedic surgeon who did the initial surgery suggested shaving off the outside edge. Thoughts?

I have only seen absolute non-unions when hardware is used and actually pushes the bone apart. You don’t have any hardware in there. If you can tolerate it, and do the activities you enjoy and want to to, I would wait. Are you weight bearing in shoes? Activity levels? Unfortunately, there is no guarantee the second surgery is going to turn out any better. I have seen patients with your result that have healed up without intervention 12-18 month after surgery. I have also seen patients that have not had complete radiographic healing, but have been asymptomatic. One thing to consider, oddly? Is Achilles stretches and posterior tibial tendon stretching. You may be putting more pressure on the outside of your foot due to rear foot or forefoot Varus (opposite of flatfoot).

I wear stretched sheepskin slippers in the office and flat slides that do not touch that region of my foot elsewhere. I can wear stretched ASICS extra wide fit Gel Nimbus sneakers. I can’t tolerate wearing a conventional shoe. I wish I never had the surgery at this point.

Yeah. I can imagine. In the states this is still on the cusp of being classified as a delayed union, and not a non-union. The AP radiograph looks closer than 3mm, crazy enough, only 30% bone contact is required to be considered union. CT is a better study, but if there is a gap, but no bone loss, per se, you may still be in luck. And, as mentioned, second surgery, or revision is not 100% either. Did you ever have prolonged time non-weightbearing? Sometimes this actually leads to atrophy, and has the opposite effect the surgeon and patient may desire.

😞 sadly, delayed healing and non-union is a risk, though rare. Hopefully things will improve soon. Seems you have a good team to help.

thanks for your comments. I’ll await my appointment with my potential new orthopaedic surgeon at the end of the month for assessment.

Best of luck!!

for reference the last X-rays in December are weight bearing so may account for less than 3mm gap?

Do you have oblique or lateral x-rays?

29 December

29 December