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Friday, May 11, 2018

Hallux Varus after Sesamoid Removal Years Later

Hello Dr. Blake,

I have just spoken with your nurse/receptionist and she suggested I describe my foot concern to you.
I had sesamoid surgery on both my feet twenty-five years ago in Pasadena California.
Up until last summer, my feet were handling my everyday wear and exercise just fine.  
But, in the summer, I decided to wear a flat sandal with no side support.  In one month my large toe on my left foot began moving off my sandal!!!  At night I experienced shooting nerve pain from my ankle up to my knee, consistently for weeks.  I saw my podiatrist and he put me in a boot.  Had no other suggestions.  I then saw three prominent foot surgeons.  They all suggested “orthotics.”  
One of the surgeons gave me a shot of prednisone in the big toe of my bad foot.  
This did help with my nerve pain and foot discomfort.  

In caring for my foot I bought wide enough shoes to fully support the expanded width of my left foot and my disfigurement. 
I am athletic and always have been.  Since my foot alteration, I am walking with orthotics.   
One week ago, I was trying to make an appointment and was required to walk for at least 35 minutes in a sandal which has good support for both my arch and bunion area. Well, I thought.  I am normally paranoid to wear only a few pairs of shoes that work with my condition.   
The result was concerning.  My foot feels that it has become disfigured even more.  

I have been compensating for the past year, to not put full weight on my left foot.  Currently, I am having knee pain in my right knee.  I transfer my weight constantly.   I have taken a bad fall heading up the stairs because of my foot alteration. Every step I take is now is a concern to me.  

My question is are you a surgeon and do you know how to repair a condition like mine?  If not, do you know a surgeon who can which you recommend? 
I appreciate your time and consideration. 

Dr. Blake's comment:

     Thanks for the email. It sounds like Hallux Varus where the big toe moves away from the 2nd toe. If that is the case, surgical correction is necessary to realign the joint. Care has to be taken not to make the joint too tight, causing a limitus condition, and thus causing more of a problem. Send me a photo of your foot for this post to make sure we are talking about the same thing. Also tell me what sesamoid was removed many years ago. It makes sense that the fibular or lateral sesamoid was removed making it easier for this to occur. 
     Since you are 400 miles from me, and our surgeon (I only perform rehab), here is a list. My go-to guy in that area has always been Dr. Altchuler (Santa Monica) 310-451-8045. But, I have confidence in Franklin Kase (Burbank) 818-848-5583, Brian Hong (Oxnard) 805-988-3338, a member of my class Leslie Levy (Valencia) 661-254-0795 and Jan Tepper (Upland) 909-920-0884. Use my name as the referring podiatrist. After they exam you, you want to get two surgical opinions. They may be one, and then get the name of the doc they would have it done if them. Keep me in the loop. Rich

Further comment: Thank you so sending me the above photos. It almost looks like a breakdown higher up your arch, then typical Hallux Varus. This will take a good workup. Please get some 1/4 inch adhesive felt from and apply to the medial side of the big toe when you are wearing shoes to push it over towards the second. Also, get an OTC arch support from Sole or Powerstep and begin to wear that it comfortable. Keep me informed. 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.