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Thursday, April 9, 2020

Removal of Both Sesamoids: Initial Advice

Hi Dr.Blake! i’m a high school freshman and I have some questions about my foot problems. In the 3rd grade I fractured my fibular sesamoid bone. They did everything they could to heal it but it ended up being a nonunion. They tried anti-inflammatory pills, orthotics, immobilization just about everything they could. I have been in pain everyday since then. I’m also a very active and committed basketball player. In August of 2019 I went to a local podiatrist and he decided to remove the sesamoid bone. 

Everything was going on track so I was cleared to play basketball my freshman season. I started playing again and about a couple weeks later it was in excruciating pain, worse than before the surgery. I went back to my podiatrist and was casted and put on crutches for almost 2 months. Finally when none of that helped I got a MRI and turns out I fractured my medial sesamoid. My best option, I thought, was to have that bone removed too. I had the surgery March 2, 2020 and am about 1 month post op now. My first question is should I be able to bend my toe by now? I am not able to and it causes pain in my toe joint. Another question is, without both of my sesamoids will my foot be able to have the same function? I really want to be able to play basketball again but i’m not sure if my foot will be able to handle it. Another thing is what are the chances of foot deformities? My podiatrist talked about it but said it was a rare chance. Last question is, my big toe and the one next to it are very sensitive and tingly is that normal? I see my podiatrist next week but I wanted a second opinion. I would appreciate if you could get back to me! Thank you! 

Dr. Blake's response:  Thanks for your email. So you have had both sesamoids removed. This means that the bottom of the joint now does not have the sesamoids to protect it. Make sure you play always with protection for this area (normally the combination of off weighting orthotics and Dr. Jill's Gel Pads). The surgery you had will tighten the bottom structures to the joint, so a physical therapist has to advise you on how to get the range of motion back. So, yes, at this point you should not be able to pull your toe up, but hopefully you will. Have the doctor measure the range of motion you have up and down as reference (both passively and actively). We want to see a monthly improvement. You have to get 75-80 degrees of the up back both passively (him pulling the toe up) and actively (you pulling the toe up). It is great for the next three months to be under the guidance for this by a PT. You do not want the doctor to minimize the situation, which surgeons tend to do, you want the honest truth about where you are. The sensitivity is from nerves and inflammation. Work with massage, ice, contrast bathes, and more massage on some routine basis. Your surgery permanently weakened the pull of the short tendons that keeps the toe straight. You could develop a crooked big toe over time, which would need further surgery, but that may never happen. I sure hope this helps some. Protect the joint, get an idea of your range of motion both passively and actively, stretch the big toe itself to keep the tissue loose, work on the inflammation and nerve sensitivities. Keep me in the loop. 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.