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Sunday, May 26, 2013

Post Partial Sesamoidectomy: Email Advice

Dear Dr. Blake,

As you know from our previous emails, I had a fractured sesamoid. After going all of the treatments, I had the surgery 11 weeks ago. My doctor made a partial sesamoidectomy for the fibular sesamoid, he only took the smaller piece of the fractured sesamoid, which already has AVN.

 6 weeks after surgery, I noticed that there are some color changes in my foot and lower leg, so they made a doppler and found out there is a thrombophlebitis around my ankle. They gave me antibiotics and anti-inflammatuar drugs and also compression socks. After 1 month, i went thru the dopler again, and now there is no clot or anything just minimal chronic venous stasis on my upper legs.

 But when I dont wear compression socks and stand on it long time, my foot which i had the operation from goes red and warm, but when i elevate it, it immediately turns normal. I have swelling as well, but not very bad. I am not applying ice or heat because I'm afraid it will affect the circulation. I never iced after surgery. 
Dr Blake's comment: Typically patients who develop thrombophlebitis are on anti-coagulants for 6-9 months so yours must have been minor. The fact that you can elevate and the circulation returns to normal is great. However, you should always be wearing, minus sleeping, the compression hose for the next 6 months all the time. Since you had surgery, and the healing process goes on for the next 9 months quite actively, you should ice pack at least once a day for 10 minutes, and do one set of contrasts each evening. 

Apart from this, before the surgery I have mild halux valgus deformity with no pain. My incision is directly on that part of my foot, i mean around the bunion area, and now it hurts with touching, do you think it will go away?
Dr Blake's comment: yes, but get a Blaine's scar kit from a local pharmacy and massage the scar for 5 minutes twice daily. It should be cross frictional, across the grain of the incision, and non painful. 

I am reading a lot, but there is not much about partial sesamoidectomy, I hope the remaining part will not hurt. Do you have any experience? I am still wearing tennis shoes with custom orthotics, I don't know when I can switch to regular shoes and even to heels(if possible).
Dr Blake's comment: Surgeries of this sort can be rehabbed gradually and progressively. First you build up your walking, without limping, and without pain over level 2, up to 60 minutes with tennis shoes. Then you slowly introduce wearing of dress shoes (wide enough not to push on the scar). When you are up to 2 hours in dress flats without symptoms, than gradually begin to wear 2-3 inch heels with a dancer's pad. 

Another thing I wonder if I can feel the sesamoid by touching, because I can feel something like a bone when I touch which is more palpable than it is onthe other foot.
I'll appreciate any answer to my concerns:)
Thank you very much...
Dr Blake's comment: Sure you can touch the sesamoid since it is right under the skin. Can I ask why you decided to the partial and not complete sesamoid removal? My readers would definitely like to know what went into your decision. 

6 comments:

  1. Actually it was not my decision To have the partial sesamoidectomy, it was my Dr' s decision. He yolda me that he decided when he saw that the sesamoid is in 2 pieces, one of which changed color and it was very very soft but the part looked healthy. Thats why he wanted To keep it. But To be honest, i thanks i can feel the remaining piece while walking and it hurts if i wear hard soled shoes.
    The weather is very hot so that i cant wear compression hosiery all the time. Are there a kind of thin that i can only put around my ankle like a bracelet and it Will help To pump the blood form my ankle to up? Because the stockings are only tight

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    Replies
    1. See my response below. Thanks for the response on the partial sesamoidectomy. I am hopeful it is going to be great. It is too early post surgery to have lost the heightened sensitivity. It is not a good indicator, perhaps for a couple of years. Rich

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  2. But the color change is not there anymore. Do i still have to wear them? İ weared it for 3 months and i am using aspirin everyday. Thanks you very much for all the answers.

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    1. Of course, you should ask your treating doctor, but sounds it would be fine to stop wearing. Support hose are hot and when you swell in hot weather they can cause their own problems. The Aspirin definitely for 9 months total, and I would start by wearing the support hose 50% of the time for one week. If you still do not notice any skin changes or swelling, try to stop wearing. Rich

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  3. Hi Doctor Blake!
    I have been reading your replies and not sure if you are still posting on this subject anymore but in hopes that you might I wanted to ask some questions. I actually had a partial sesamoidectomy. I think your anonymous writer is the only other person that I have found that has had this type of partial surgery. My doctor suggested this route because most of my sesamoid bone was healthy and no arthritis or any other ailiments. I had an injury many years ago that possible broke my bone in half but where it broke was nearer the bottom so it was too tiny to put a screw in. I had pain in my foot off and on for years but it was like flair ups and then the pain would reside and no big deal go on my way, however I had a cortisone shot done for my hip (which is another injury that I am facing and a couple of months after the shot that pain in my foot was back, it felt like a stabbing knife pain and this time it was not going away it was debilitating and extremely painful. I am not sure if the cortisone weakened the bone break even more but I can't really figure out what the culprit was all I know is I could not bear the pain any longer and this thing was not going way like in the past. So I went to see a foot and ankle specialist with an xray he was able to see my injury to my sesamoid bone closes to the end of my foot. He could tell that it was an old break that happened a along time ago that did not heal properly. There was scar tissue between the bones where it tried to heal its self. So and every time I took a step the two bones were bending up and down, your sesamoid bone are not suppose to bend right!! Ouch! So of course I did the conservative route just like everyone else with no relief it finally came to a point that I had to make the decision to just have surgery done. I am 7 weeks out post op. My scar is healing great I do deep tissue massages on it every other day. Toe strengthening and stretching. I am walking in a pair of comfortable boots, a tennis shoe with custom insoles, and some dearfoam thick comfy sleepers. I walk when I need to but I do a lot resting still and elevate my foot often. I still sleep with my foot elevated most nights. I took pain meds half dose for the first 3 days post surgery. I really didn't want to but I couldn't sleep and sleep is when we do our best healing so I took them to sleep. Now 7 weeks out I still have pain where the cutting took place. I think from reading this blog and the research that I have found this pain is normal and probably due to nerves being healed. My doctor said I could have this tenderness for up to 6 months possibly a year. I see my doctor again in 5 weeks which will be my 3 month appointment. My doctor did say however if the pain persist we may need to go in and take the other part out, but he mentioned that this is probably unlikely since the rest was healthy. If it wasn't he would have taken the whole bone in the surgery. He is under the impression the more original anatomy you have the better. I felt good with my decision to have a partial done. Now for me it just having patients and not over doing it. I guess my question to you is does this sound normal at about the 7 week mark? Also I can feel that partial sesamoid bone like your other responder, and it feels tender but the super sharp pain is gone since that smaller part is out. My other question is do you think it will take longer to heal with a partial sesamoidoctomy since there is still bone left and I heard that bone takes longer to heal. Or should I have just had the whole thing removed from the beginning?

    Thanks
    Kimberly

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    Replies
    1. Hey Kimberly, I answered tonight on the blog. Rich
      http://www.drblakeshealingsole.com/2015/01/partial-sesamoidectomy-email-advice.html

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.