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Monday, November 21, 2011

More Advice on Sesamoid Injuries: Email Style

Again I must apologize to Tammy and all who have been waiting for me to respond to their email.s. Thank you Tammy for re-emailing me to get the ball rolling again.

Hi Dr. Blake,

I sent you an email with lots of questions about a month or so ago.
Dr Blake's comment: Sorry!!

 This is the link if you need:

 I have a couple other questions for you. I saw a podiatrist and he suggested removing the fibular sesamoid bone rather than trying the bone graph that the orthopedic doctor suggested. So I am waiting to see him again to schedule surgery.
Dr Blake's comment: I just have not seen bone grafting on this injury, plus bone grafting causes unpredictable amounts of bone growth (perhaps into the wrong areas).

 My question is about the surgery to remove the bone, what are the statistics for the surgery as far as positive and negative outcomes?
Dr Blake's comment: I do not know statistics, but these surgeries do very well. If I was to have surgery, I would remove it and then protect it for the rest of my life (sounds harder than it is). My patients do well, but Keely due to some pain did not return to running, and I am not sure why.

Also how long does it take to recover from the surgery mostly in order to return to work and of course to the dojo too. I am still working to find a comfortable arrangement of the taping and the off setting the foot with the pads, that is a work in progress.
Dr Blake's comment: So, it is normally 4 days on crutches, then another 10 days to 17 days until the sutures can be removed. Once the sutures are removed, then soaking, swimming, sweating is allowed. Physical Therapy is started at 2 weeks and runs initially for 10 weeks twice a week. Some time over the first year there may be another bout of 10 physical therapy visits for some reason. The return to work is based on need of feet. I sit on my butt most of the time, so I would be back at work in 4 days. Most of my patients are smarter than me and take 2 weeks off. Your work has to be tolerant of time off for PT, but many places office after, before, or Saturday appointments to get those 2 in per week.

While looking at new posts you have made I found this link:

 and I have a question about the pictures. On the fourth picture where you are showing the placement of the felt, the boot you are showing is much shorter up the leg than I have been able to find. It looks like it comes up just above the ankle. If this is so, where can I find one? I have just about worn out my second cam walker and I have been looking for one that is this low.
Dr Blake's comment: Here is the link:
You want it to grab your ankle so there is no motion there.

My final question is about orthotics, the doctor suggested purchasing orthotics with a morton's support which is supposed to keep the big toe side of the foot straight. After I have surgery to remove the bone, will that be necessary or will the orthotics need something different?
Dr Blake's Comment: Normally, after surgery, a reverse Morton's, also called a dancer's pad, is used to off-weight the area.

 If I am going to buy the orthotics which are not covered by my insurance, I would like them to be good for a while until I wear them out. Or is this something that I talk to the person when they fit them?
Dr Blake's comment: When you talk to the orthotic guy/gal, make sure they are willing to experiment between forefoot supports (Morton or Reverse Morton corrections) and pronation control (some guarentee that your weight at pushoff will be more in the center of your foot for awhile).

I have been using the bone stimulator for about 3 months over night, wearing the cam boot daily with taping and the padding to off set the foot placement.

 I am not consistent on taking the vitamin D and calcium or the soaking which I am working on since I know it will help.
Dr Blake's comment: You must do these things or Santa will leave coal. Please know how vitally important it may be to your health.

 This weekend marks 8 months since the injury and I feel my foot is in the same situation it was 5 or 6 months ago. Reading the information from your blog helps to see what you suggest and how others are dealing with this injury. I appreciate your wisdom and your willingness to share that information with everyone. Thank you again for your help and have a wonderful Thanksgiving!

Tammy, I hope this helps and I am soo soo sorry for the delay. Rich

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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.