Nerve pain after bunion or hammertoe surgery: what’s normal and what fixes it

Your bunion or hammertoe was fixed. The toe is straight, the bone has healed, and you’re glad you did it. But one spot by the scar burns, or zaps when your shoe rubs, or the side of your big toe feels strange. That is usually a small nerve, and it is a problem nerve surgeons know how to treat. Here is what is normal, what isn’t, and what can be done.

Can bunion surgery cause nerve damage?

It can, though serious nerve trouble is uncommon. Bunion surgery itself has a strong track record. Results are generally favorable, with high patient satisfaction.^[7]

Four small sensory nerves surround the big toe. They carry feeling from the top, sides and bottom of the toe, and they can be injured when a bunion is corrected.^[1] The most studied is the dorsomedial cutaneous nerve, which runs along the top and inner side of the big toe, and injury to it during big toe surgery is not uncommon.^[1,8] A study of cadavers found a constant branch of this nerve in the path of a top-inner incision.^[2] The nerve on the bottom-inner side of the big toe can also be affected, and a scarred, painful version of it is called a Joplin’s neuroma. It most often follows bunion surgery.^[9]

How often does it happen? It depends on the technique and on how carefully the nerve is protected:

• In 1,088 minimally invasive bunion procedures pooled in one review, nerve injury occurred in 2.2%, and patient satisfaction was very high.^[10]
• In another review of 766 feet after a minimally invasive bunion correction, nerve injury was among the most often reported complications, and the overall complication rate was comparable with open surgery.^[11]
• When surgeons found and protected the nerve using a small vein as a landmark, there were no complaints of numbness or scar pain in 171 big toe operations.^[8]

Many people also have some loss of feeling in the big toe before surgery. In 61 big toes with bunions, only 21% of patients noticed sensory symptoms, but testing found reduced feeling in another 44%.^[12] So not every numb patch after surgery is new.

Can hammertoe surgery cause nerve damage?

Rarely. Hammertoe surgery works on a small toe with small nerves nearby, but in published series lasting numbness is uncommon:

• In 95 toes fixed with pins, one (1%) developed partial numbness.^[13]
• In 43 second toes corrected through tiny incisions, one (2.3%) had lasting numbness, and 88.4% were satisfied or very satisfied.^[14]
• In 179 people who had minimally invasive toe correction, no nerve or blood vessel problems occurred.^[15]

Our sister practice explains bunion surgery (external site) and hammertoe surgery (external site) in detail.

What is normal numbness, and what is a neuroma?

After an open bunion operation, 31% of 98 people reported scar symptoms. The average discomfort was 3 out of 10 and lasted about 28 weeks, and 95% had none at one year. People who tried simple non-invasive treatments got better faster: an average of 19 weeks versus 44.^[3]

That is the normal pattern: a mild, numb or tender scar that slowly fades over months.

A neuroma is different. When a nerve is cut or badly injured, its fibers try to regrow, and with nowhere to go they bunch into a knot. Up to 60% of these neuromas are painful, because the knot is extra sensitive to pressure and its fibers cross-talk.^[4] Signs that point to a nerve problem rather than normal healing:

• burning, electric or shooting pain near the scar or into the toe
• a spot that zings when you tap it or when a shoe presses on it
• pain that gets worse over time instead of better
• sensitivity to socks, sheets or shoes on the inner big toe

Severe nerve-type pain after bunion surgery can be the clue that this small nerve was damaged.^[6] Pain with color, temperature or swelling changes can also be complex regional pain syndrome (CRPS), which needs prompt care. See CRPS after foot surgery: early signs.

How do you treat nerve pain after bunion or hammertoe surgery?

Treatment starts with non-surgical care such as desensitization, nerve pain medicines and sometimes injections.^[4] A small numbing injection at the nerve, arranged with another specialist, can also help confirm which nerve hurts. Many people settle with time and these steps.^[3]

When they don’t, surgery is the next step.^[4] Dr. Efe Ozturk, a double board certified Foot and Ankle Surgeon and podiatrist, performs neuroma surgery for appropriate patients. The options depend on whether the nerve is cut or trapped in scar:

• Freeing the nerve (neurolysis). If the nerve is intact but bound in scar, it can be freed and covered with healthy tissue. In people with pain for more than two years or more than two earlier operations, this approach and moving the nerve end did better than other methods.^[5]
• Removing the neuroma and burying the nerve end. In nine people with dorsomedial nerve pain after bunion surgery or injury, the nerve had been cut or trapped in scar. Removing it and burying the end in bone brought marked relief, usually within days, and all were satisfied.^[6] For Joplin’s neuroma, removing the neuroma and placing the nerve end deep in the arch gave excellent or good results in all 7 people treated that way. The eighth, whose nerve end was not moved, had a fair result.^[9]
• Targeted muscle reinnervation (TMR). The cut nerve is joined to a small motor nerve of a nearby muscle so its fibers have somewhere to grow. In 19 people with neuromas of the nerves on the top of the foot and ankle, most had complete resolution of their symptoms.^[16] See TMR.
• Regenerative peripheral nerve interface (RPNI). The nerve end is wrapped in a small graft of your own muscle to give it a target. It was first used after amputation and is now used for other nerve pain after injury.^[17]

Across pooled studies of neuroma surgery, pain fell meaningfully in 77% of patients.^[5] In another analysis of 1,150 neuromas, 70% had good results, and TMR reached 82%.^[18]

How long should you wait?

Give normal scar numbness several months. Simple measures shorten it.^[3] But don’t wait a year with burning or electric pain that is getting worse. In the Joplin’s neuroma series, everyone had already tried more than six months of non-surgical care before surgery.^[9] Nerve pain can also sit alongside a bone or joint problem. In the dorsomedial nerve series, most people had another foot procedure, such as a revision bunion operation, yet all could tell their nerve pain apart from bone or joint pain.^[6]

What are the limits?

Most of these studies are small, with no comparison groups, and no single nerve technique has clearly beaten the others.^[5,19] About three in ten treated neuromas did not have a good result in the pooled analysis.^[18] Landmarks for protecting the big toe nerves were mostly mapped in feet without bunions.^[1]

Common questions

Is numbness after bunion surgery permanent?

Usually not. In one study, 95% had no scar symptoms at one year.^[3] Numbness from a nerve that was cut may last longer, and a painful neuroma can be treated.

What is post surgery nerve pain?

It is burning, electric or shooting pain from a nerve injured or trapped during an operation. Our nerve pain after surgery or injury page explains the evaluation.

Should I go back to my bunion surgeon?

Yes, start there, and bring your operative report to any nerve evaluation. A nerve opinion adds to that care, not instead of it.

When to see a specialist

Book an evaluation if burning or zinging pain near a toe scar lasts more than a few weeks, is getting worse, or keeps you out of shoes. We see patients in Lyndhurst, Paramus and Millburn. Please call our office at 908-215-5953 to inquire about your insurance.