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Thursday, November 27, 2014

Post Sesamoid Removal: Email Advice


First of all, Happy Thanksgiving to all of you. Whatever our circumstances, we all have some thing to give thanks for. I am very grateful for all the love I receive from family and friends and people I interact with. 

Second of all, I want to thank my readers for today this blog went over 1,000,000 page views. It is mind boggling, and humbling. I am proud and honored to have helped some of you, by at least pointing you in a different direction to try. Thank you. Rich

      Hi, Dr. Blake! I have a quick question for you... While I continue to have pain and issues after my tibial sesamoidectomy, bunionectomy, and fusion of second toe procedures, I have been pushing along using orthotics, TENS, stretching, PT, etc. I find that trekking in woods or doing some hikes (granted, I have been learning my limits...) is easier than walking on flat land, as I don't have to push off as much... I also row, use weights, and do Pilates/yoga to stretch and strengthen...


     My PT thinks I need to focus more on using my ankles/other muscles instead of my toes as much when I walk. With my high arch, I realize that I will continue to have issues after all of the surgical procedures, but I will live with it. That said, I am curious--my last MRI from a couple of months ago showed that I had "thickening of the flexor hallucis tendon near the lateral sesamoid", which is thought to be due to "chronic stress injury and/or post-surgical changes." This was shown on the MRI from April as well. Can this be considered flexor hallucis tendonitis?
Dr Blake's comment: Yes, that can be considered chronic tendinitis with more scarring and less inflammation at the time of the MRI. 

     I am just trying to figure out how to approach it at this point, as when I have very bad pain cycles, the first met head (right in ball of foot) is very painful to the touch, and feels inflamed constantly. It hurts no matter what I do. So when I am active, I make SURE to sure to use orthotics or rocker shoes, apply Voltaren gel, etc.
Just wanted to get some thoughts from you!
Thanks!!
Dr Blake's comment: You are probably doing what you can. There is so much force on the ball of the foot with a high arch foot. Make sure you use Cluffy wedges and dancer's pads (as described in this blog). Ice pack with reusuable packs daily for 10-15 minutes even when there is no pain. Attempt to strengthen the FHL and FHB tendons as best as you can (FHB with met doming and FHL with towel curling exercises). I do have patients with high arches that custom orthotics make too much of an arch. With the arch high, the metatarsal can get pointed downward too much. To check if this is the case, try a simple OTC orthotic like Sole. Place a dancer's pad on it. Check if the pressure on the ball of the foot is less. I hope this helps some. Rich

2 comments:

  1. Hi Dr. Blake,

    I'm not sure if this is the best thread to ask my question on, but I couldn't find exactly what I was looking for.
    I just had my stitches taken out yesterday from having my sesamoid (tibial?) removed. I had the same procedure on my other foot 4 years ago by an awesome doctor in Monterey. Unfortunately, this time it was done by a Navy doctor and I had no choice. They don't seem to care all that much about recovery and follow up and the only instruction I was given yesterday was to grab my big toe at the base and push it as far forward and backward as I could for an hour a day. She said if after a month it's stiff, then I could do PT. Does that seem normal to you? Last time I did PT right away for a couple of weeks.

    It just seems really stiff and there is a lot of numbness. Nothing like last time. I just want to make sure that there isn't anything else that I can be doing since I've been left to my own devices for healing it.

    Thank you so much for any info you can send my way for stretches or ice/heat therapy suggestions for 2 weeks post op!

    ReplyDelete
    Replies
    1. Hey Amber, sorry for my delay in responding. I hope you are healing well. You should definitely get a referral for PT which is typically started between 2 and 6 weeks post op. Three times daily you should either just lay your foot on an ice pack for 15 minutes or do contrast bathing (as long as you are doing something three times daily to influence the joint swelling). I do not think you should just move the joint up and down (see my post on Hallux Self Mobilization). Do you have protective orthotic devices and/or can you make dancer's pads, but it is important to off weight the surgical area for the next year at least to some degree? You can definitely start doing metatarsal doming three times a day, and even flat footed balancing with the ball of the foot off the ground. Hope this helps you some. Rich

      Delete

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.