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Tuesday, May 27, 2014

Sesamoid Surgery: Email Advice

Hi Dr. Blake,
Four months ago I had a sesamoidectomy after 2 years after the onset of my pain.  My post surgery follow-ups were with the orthopedic's assistant who was pretty clueless about the recovery.  He ended up referring me to a physical therapist which has helped reduce the scar tissue and increase my big toe range and strength as well as helping me to stop walking on the outside of my foot as I had for 2 years. 

     But I am now at the end of therapy and I still have stubborn scar tissue which is somewhat tender to walk on. Also as soon as I began the therapy and strengthening and stretching the toe I began getting numbness and tingling in the toe.  It's pretty persistent, but the "toe curls" increase that sensation.  This may sound strange, but that nail seems to have slowed/stopped in its growth.
Dr Blake's comment: Surgery is an incredible event that your body must deal with. All bodies deal alittle differently, but overall the surgical area gets the majority of the blood supply for healing, some being shunted from other areas close by. The nail may be alittle poor on blood supply for a while, but should come back to life within the next year. 

    So I am curious to know what is "normal", how long these symptoms may last, if they may be permanent and what I might still do to promote recovery.   Thanks for any insight or experience you have in this area.  

Regards, Bill (name changed)

Dr Blake's response:
     Thank you so very much for the email Bill. You are on the surgical plateau from 3 months post surgery to 9 months post surgery. It can feel like nothing is happening. This is when you stop PT in general, and do your daily stretching, strengthening, scar mobilization with Blaine Surgical Scar Kit, Hallux Self mobilization (as described on my videos), anti-inflammatory measures like icing and contrast baths, and wear your protective shoe inserts. Continue to honor the pain, keeping between 0-2 pain level. The next big change will be between 9-12 months when scar tissue maturation occurs. You will see during this period that the exterior skin changes from red to white. You will gain some range of motion. Your gait (walk) push off will be better. 
     So, during this next 5 months, when nothing happens quick, be diligent on daily stretching, mobilization, strengthening, scar manipulation, anti-inflammatory, and protection. It is hard to do, but very important, and for some, crucial. Hope this helps some. 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.