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Friday, June 14, 2013

Post Sesamoid Removal with a Unusual Twist of Cartilage Removal: Email Advice

Dear Dr. Blake

     I had to have a sesamoid bone removed, the one where the incision is on the side of my foot. I also needed to have cartilage removed because it was dead or dying due to the injury. I had to wait 6 months after the injury for the surgery to get approval.

    Now, it is very painful to walk and my great toe joint is bending back and to the left. I use my hands to move it every night. But every morning it is so stiff and it is painful when I am bending it. Is it possible that during the surgery one of the tendons was accidentally cut? 

    I had the surgery in march 2013 and I still do not have normal sensations in the toe. It is partially numb and feels tingly when I touch it. If I am on my feet and fairly active it swells up, turns a bluish color on the top of the great to joint, and the pain gets worse. I always ice it in this case. MY question is I have a job that requires me to be on my feet for most of the day. I must wear boots as well and I dont think my foot would even fit into my work boots. Are these symptoms normal for the surgery ? When can I anticipate being 100 % Thank you for your time Doctor.

Dr Blake's response: 

    Thank you so very much for the email. You had major surgery on your big toe joint that may take several years to mend. Since you had cartilage also removed, the healing pattern is not as predictable as just removing a sesamoid. Basically you have an arthritic joint, and everyone is hoping you can walk on the damaged bone afterwards. See if you can push to get an MRI and send me the disc or email me some images. If you get to that point, I can help you decide which ones to send, but you can look at typical MRI images for Hallux Rigidus in my blog. 
     Start working with the podiatrist/orthotist to get boots 1 size longer so you have ample room to fit a protective orthotic device in there. Ice for 10 minutes twice daily the bottom of your foot, and do contrasts baths once daily to remove deep swelling within the bone. Massage into the area Neuro-Eze twice daily to help with the abnormal nerve sensations. I hope this helps some. Rich

PS We always must assume that the surgery was done correctly and that the expected outcome is for full recovery. However, complications of some sort occur in 10% of all surgeries (mostly minor). If your surgeon did not paint a doom and gloom picture after surgery, they are expecting complete recovery. However, you need to respect your symptoms and gradually increase activity, as you create a pain free environment, and work on the inflammation. Hopefully you are in shoes, removable boot, inserts that are protecting it as you walk. From there, you can safely and gradually add more motion and less protection, but you have to find out exactly what it takes to get pain free at this point. 

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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.