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Sunday, October 27, 2013

Post Sesamoid Surgery: Email Advice

I am a Detective and in an office setting most days but of course have to be 'fit for duty' with the ability to run, chase and fight at a moments notice. I had a sesamoid bone removed 072913 (i broke it in two after chasing a bad guy in May 2012 and the doctor let me walk around it until 07/2013) and have been home since.

 I had one post surgery visit and he said "start putting weight on your heel" so I did that. 6 weeks later I went for my second post surgery visit and I cant bend my toes without pain, there is a burning sensation on the top of my big toe and at the bottom of my incision scar is a "lump" that is very painful. I think it is scar tissue and when I touch it, it is very sensitive. I still can not put my weight on this area therefore I am walking on the outside of my foot (according to my tennis shoes) and not putting any weight on the inside ball of my foot because of the pain.

 Last week I was released to "light duty" with restrictions of no more than 15 min walking or standing an hour.... is this normal?
Dr Blake's comment: This sounds like the surgeon's mantra: "To cut is to cure". Surgery is really just the start (normally a good start) towards being well again. This is the hope of every patient when they go to surgery. And with sesamoid surgeries, this is what you should expect. It is hard to know what is going on right now. Are you just more painful than most, or is this a complication? You really have to create a pain free environment with a removable boot, orthotics, dancer's pads, stiff sole shoes, etc. Whatever it takes, and with whatever combination it takes. You are the surgeon's responsibility so have a heart to heart conversation. You should be icing twice daily with 10 minute ice pack, and doing a 20 minute contrast bath each evening. Read my posts on sesamoid fractures which talk about how to protect the sesamoid. 
Should I get a second opinion because I don't feel my surgeon "cares" now that I am back to work and I am in pain still. I have began to take my hydrocodones at evening time again and my foot is so sore on the top (tarsals) I think because I am walking wrong.
Dr Blake's comment: You really need to talk to the surgeon. Say you need advice because you think you have more pain then you should. Find if he/she believes physical therapy would help you. Physical therapists see you typically after the stitches come out, and you are ready to get the joint calmed down, un swollen, and moving again. Ask the surgeon if the Blaine scar kit is appropriate. Ask if an agent like Neuro-Eze would help reduce the pain and allow you to massage the injured area. Pain free self massage is always good to a painful area. Tells the brain to not be so hyper about it. 
What do I do? Should I be home letting this heal properly? Should I anticipate additional surgery to eliminate this pain? Is this amount of pain normal?
Dr Blake's comment: This could be where a second opinion comes in. Not to transfer care, because that would be hard to advise from afar, but just to say yes or no to some of these questions. Second surgeries are rare post sesamoidectomies, but secondary problems because you are not doing a good post operative program are not uncommon. Good luck, and please keep me in the loop. 
Thanks for your reply and assistance.

1 comment:

  1. Hi! I'd love to hear how this person is doing, trying to gauge if a sesamoidectomy is worth it !


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.