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Wednesday, January 7, 2015

Partial Sesamoidectomy: Email Advice


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 x ray he was able to see my injury to my sesamoid bone closest to the end of my foot. He could tell that it was an old break that happened a long 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 and 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, and 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 patience 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 sesamoidectomy 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

Dr Blake's comment:

     Kimberly, Thank you. This is such a rare procedure, that the med profession is learning on you. Everything sounds good. It is early, but I love the concept of leaving the good part in there. Please keep us in the loop with monthly or bi-monthly updates. I would think that it will take less time to heal if you leave 1/2 in, but I really do not know. Good luck my friend. Rich


6 comments:

  1. Hi Dr. Blake,

    So I am now at 9 weeks post op. I am still wearing stiff sole shoe and doing my therapy. I have tenderness still wear the bone was cut. The thing that causes the most pain is when I wear tennis shoes and up on my tip toe it kills. I also feel some pain under my large toe I think this is due to my tendon that attaches there. Can you give me any input on what you think of my healing so far. I don't see my doctor until 3 more weeks.

    Thanks again Kimberly

    ReplyDelete
  2. I had my 12 week 3 month post op visit today. I still have tenderness my doctor said this is due to inflammation. Inflammation can last along time. Since I only had partial sesamoid bone removed when should start to worry that the pain does not go away. 6 months or 9 months or a full year. At what point do I make the decision to get the whole bone out? Most people that have done 1/2 sesamoidectomy surgery it does not solve the problem.

    Kimberly
    Thanks Kimberly

    ReplyDelete
    Replies
    1. Kimberly, You have to take this one month at a time. By doing the surgery, you basically commit to a year of patience to see how things go. You have to create a 0-2 pain free environment, set your benchmarks of what you can and can not do now, and without increasing the pain, see if each month you can reach new plateaus. So, what you did in January should be increased without increase pain in February, and then increase function in March, etc. The point tenderness may be the same in August as it is now, but as long as function is increasing, you are getting better. Hope this makes sense. Rich

      Delete
  3. Thanks very helpful advice. The key is patience. Quick question you mention "daily contrast baths for deep flushing" in a blog. Is this warm to cold water baths to help with circulation?

    ReplyDelete
  4. i am not the author:
    i have tibial sesamoid fractured too from running backward at high intensity, had small bump in my new shoes and broke my sesamoid and felt the pain immediately, i got MRI and seen at least 8 specialist... after 1year they told me i had fractured my sesamoid, i stilll have pain i went see a orthopedic surgeon and he told me he could remove a part of my non-deplaced sesamoid fracture(a very small liquid is between the 2 part shown on MRI a month ago. so his idea is to remove the smaller part(about 45% of the sesamoid..) do you think its a good solution? he think the pain is coming from that sesamoid not healing completely. But i hesitate so much on getting the surgery im so scared the problem become worse.. and another weird thing, when i walk in the sand its magical for my sesamoid pain, i cant explain why walking in grass and in sand help me and anything involving anyking of shoes or sandals or anything give me pain. I learned to live barefoot because thats truly helping me. when i stand on my sesamoid i dont have pain, but when i touch it i can get about 8/10 in pain also bent it cause pain. But if i keep my feet flat i have no problem. One important thing in my case is i learned 1year after the acute injury that i had fracture because they didnt seen it on x-ray. then 1 year later i bought a MRI and they finally seen small crack in the sesamoid that is non-deplaced fracture. Another thing is that my feet now cracking all the time when i walk and it never been like that before the injury.

    Its impacting a lot my life and tried everything i could, at this point i have 3 solution that i found could work:
    1- Live on the beach 24/7 in a hut where i would NEVER walk on hard surface(dont have that $$$ to do that)
    2- Have sesamoid removed partial or completely
    3- I never been in the boot, they told me its too late after a year, is it true? do you think if i put my feet in a boot pointing my toes downward for a while could fix my problem?? im thinking about trying this

    please come me back dr.blake you ARE the ressource on the sesamoid over the internet!!!!

    thanks keep up the good work and sorry for my broken english

    ReplyDelete
    Replies
    1. I answered this comment on my blog 10-17-15. Sure hope it helps. 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.