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Sunday, October 27, 2013

Sesamoidectomy: Patient Comments

Dr Blake,

I just wanted to send you a note to say thank you so much for taking the time to write your blog. It has been a huge help to me over the last year as I've gone through the drama of a sesamoid fracture. I thought I'd share my story with you. I'm sure you've heard plenty that are similar, but I hope you don't mind adding one more to the list. 

I fractured my lateral sesamoid (I think - it's the one closest to my 2nd metatarsal) July 2012. I was referred to a podiatrist, and at my first appointment she diagnosed me with a stress fracture of the 2nd metatarsal even though I kept saying that the source of the pain was right around that sesamoid. Nothing was showing up on xrays at this point so she told me that it had to be the 2nd metatarsal and that the pain was just deflecting for some reason. 

I was put in a walking boot for 6 weeks, which I diligently wore until I was told I could start to wean myself out of it. A week after I was finally out of the boot completely the podiatrist told me I could start a walk/run routine and build up slowly, as well as slowly begin swing dancing again (a hobby that my husband and I do together). I danced for a total of 30 minutes in 1 week and my foot ended up swollen and in more pain than before. I couldn't get in to my podiatrist for a week, so I put myself on crutches, ice, and elevation until I could get in to her. By the time we got to do an MRI a week after the swelling, I had managed to get all the inflammation down, but could not get comfortable in the walking boot again. So the podiatrist suggested spica taping and a dancers pad in walking shoes. The MRI also showed a fracture on the sesamoid at this point but nothing wrong with my 2nd metatarsal. So, I started doing my research online and found your blog, watched your videos to learn how to tape, and went from there. I used your taping method and a dancer's pad for 6 months straight while I went through the rest of my story. 
Dr Blake's comment: A bone stimulator would have been great at this point, and some discussion of dietary calcium and Vit D3, and the use of icing and contrast bathing daily (my favorites). 

By January 2013, my husband and I had to move to a new city for work, so my podiatrist sent me on my way with a referral to a PT for 6 weeks to try and get my foot healed completely in our new location. Four weeks into PT, the PT told me she thought I still had a fracture based off of my reaction to ultrasound therapy, and sent me for more xrays/MRI and suggested I go to a new podiatrist. My regular doctor also sent me to an orthopedic surgeon for another opinion. 

These xrays and MRI showed the fracture had not healed, the bone was fragmented, and there was signs of necrosis. 
Dr Blake's comment: Necrosis alone can be treated with bone stimulator, necrosis with bone fragmentation sounds surgical to me. 

The orthopedic wanted me to just stay off of my foot for another 9 months and see what happens. Just taping and a dancer's pad was all he wanted (oh, and he said soft-soled shoes, which I found really bizarre after reading your blog). I wasn't happy with a wait-and-see solution, as I had pretty much done that for 9 months already and couldn't understand how another 9 months would help. The new podiatrist, on the other hand, felt that with the state of my sesamoid it would be wisest to remove it. He said he didn't see much hope in it healing considering the damage he was seeing, and that we were at the stage of last resort. Normally I do not jump on the surgery band wagon quickly, but I didn't see much of an alternative either. Even the orthopedic had given the same diagnosis on my bone, he just wasn't willing to cut it and was hoping for a miracle. I queried e-stem but the podiatrist said I probably had about a 30% chance of that working, and considering I had just found out I was pregnant he didn't think the crutches for 9 months would be a safe idea. 
Dr Blake's comment: Congratulations!!!!!

So we waited until I was in my second trimester, got my midwife and an OB to both approve the surgery (they also felt it was better to take the bone out before baby was born so I had more time to heal before caring for a newborn), and made a plan with an anesthesiologist to do the whole surgery with a block instead of a general anesthetic. I took the brave step and had the sesamoidectomy 2 weeks ago, 13 months after this whole thing started. The good news is that the bone ended up not necrotic or fragmented when they got into my foot. It came out all at once, but either tissue or cartilage (the doctor said he'd have to order a lot of labwork to tell) had grown into the fracture, so the podiatrist said that it never would have healed properly and it was probably good we took it out (I hope this sounds right. It was a little overwhelming to hear right after surgery). 
Dr Blake's comment: I hate MRIs for the read of avascular necrosis. It scares many patients into unnecessary surgery when bone stimulators can help. I am unclear however how the bone fragmentation was not fragmented. I think MRIs show more internal disarray that we read as external disarray (ie. fragmented). But, soft tissue in the fracture would mean it could not heal. So, let's accept that as fact. 

Although I'm only 2 weeks out, and still non-weight bearing (I go for my 2nd post-op appointment this afternoon to see if I'm ready to start moving into weight bearing), I'm amazed at the difference I already feel. I used to get sesamoid pain even sitting on the couch or lying in bed, and now I don't. I haven't really needed any pain killers except for maybe a couple of times in the last 2 weeks. Normally the pain is staying below a 2 (yay good pain!), and icing the back of my knee (a trick one of the OR nurses taught me in recovery) reduces the swelling enough to lower the pain if it gets any higher. I have a little bit of weird nerve sensation in my big toe, but I see from some others on your blog that this seems to be a fairly common feeling post-surgery. 

Again, I just wanted to thank you for your blog. Your different posts on this issue has been helpful to read and has made it much easier for me to know what to ask and what to expect. I'm hoping that my foot continues to feel as good as it does now, but I'll admit I'm slightly nervous for the weight-bearing stage. 

Fingers crossed! 

Dr Blake's comment: The love this patient is really pouring out to anyone of you with sesamoid problems is easily felt. Thank you for your real time experience and honesty, something I can not give the reader. It is immensely vital. Keep me in the loop and to a gradual but easy healing!!! Rich

2 comments:

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  2. How is the recovery going for this patient? I am considering a sesamoidectomy after dealing with sesamoiditis for 14 months. i'd love to hear how the long-term recovery went. Thanks!

    ReplyDelete

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.