tag:blogger.com,1999:blog-673715911736059911.post5900419070234114151..comments2024-03-01T17:52:55.066-08:00Comments on Foot and Ankle Problems By Dr. Richard Blake: Recent Fibular Sesamoid Removal: Email AdviceUnknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-673715911736059911.post-65413531910342875112016-03-26T11:05:21.153-07:002016-03-26T11:05:21.153-07:00Once you have had pain for awhile in any area, sur...Once you have had pain for awhile in any area, surrounding areas begin to hurt as a form of protection. Since a cortisone shot helped into the nerve, I would still go with neuroma and consider more shots of cortisone or alcohol. Of course, metatarsal pads to off weight, and sometimes splinting (need to start wearing loose and gradually tighten up). Icing and contrast bathing in some form twice daily is crucial to try to keep the symptoms between 0-2 as you increase activity. RichDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-84851845919791108162016-03-23T04:07:49.811-07:002016-03-23T04:07:49.811-07:00I went back to podiatrist yesterday. He pressed a...I went back to podiatrist yesterday. He pressed around on the foot and said that if it was just a neuroma it should only hurt on the bottom of my foot but I was also having pain on the top of the 2nd and 3rd toe joints. He now thinks that maybe there is inflammation in those joints which is causing the nerve to be inflamed and he said that can be very difficult to heal. He put another pad in my shoe and taped my 2nd toe downward, but the way he did it just about cut off my circulation and caused it's own pain. He prescribed an anti-inflammatory and told me to ice it every day, which I have been doing frequently anyway. Does this sound right?<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-90944945872888641042016-03-11T17:38:26.868-08:002016-03-11T17:38:26.868-08:00I would suggest emailing me with the whole history...I would suggest emailing me with the whole history so I can get a better feel of what is going on. If you have a written history, just email to me and I will respond. RichDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-55499884481424402372016-03-11T07:54:40.854-08:002016-03-11T07:54:40.854-08:00The pain in the big toe joint still bothers me but...The pain in the big toe joint still bothers me but not as consistently, but when it hurts it is a sharp pain, usually on the underside of the joint. The neuroma is still a huge problem for me. I received a cortisone shot between the second and third toe in January. It helped some of the burning sensation go away but if I stand for more than 20 minutes on the concrete floors as work, it feels like my foot becomes the size of a basketball. My podiatrist at first thought it was from the bunion but then when he finally took some time to actually look at my xrays, he said that he did not think that was the case. I do now have my orthotics, which I wear all the time in my good athletic shoes and they do not really seem to help a whole lot. I did go and get a second opinion and he suggested I get more cortisone shots. Would you generally recommend that? Or do you have any suggestions? Thank youAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-74831617860199371862015-10-03T17:16:07.462-07:002015-10-03T17:16:07.462-07:00Okay Jill, It is so good about the range of motion...Okay Jill, It is so good about the range of motion. That is a good indicator of health in the joint. I hope the cortisone and orthotics help. Continue icing twice daily to reduce any daily irritation. Keep me in the loop. RichDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-35640090214248795862015-10-01T08:15:44.046-07:002015-10-01T08:15:44.046-07:00Thank you for your time. I did finally get in to ...Thank you for your time. I did finally get in to see the podiatrist today for the orthotics he had recommended. i explain the pain and he says that it is a bunion. I told him that he said I did not have one in the foot so he responds that he doesn't know why he would have said that. he said the orthotics won't help bunion pain. I explain that none of this pain started until my accident, not I can hardly drive. I also explained how my PT said that my other issue between the 2nd and 3rd toe is a neuroma. He says the orthotics may not help that either. So I am confused. I forgot to ask him about the possibility of the bone edema that you had suggested. He ends up giving me 2 cortisone shots on the top of that 1st knuckle. The second one he had trouble with because it seemed there was a lot of scar tissue. I ask if that could be the cause of the pain and he said yes. He is ordering the orthotics and I hope the cortisone does something. But I must say I left the appt very frustrated.<br />As for my range of motion, that is doing well. I notice some hyerpsensitivity and I think that the PT would say that I don't have full strength yet in the flexor tendons. <br />Thank you again!Jillnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-42579968757241980072015-09-26T15:23:25.107-07:002015-09-26T15:23:25.107-07:00Wow Jill, I will try. The best you can do is have ...Wow Jill, I will try. The best you can do is have a visit with the PT. Ask he/she to fax me their observations and concerns at 415-353-6401. On the fax, identify that you are a patient from my blog. I would need to know about joint limitations of motion, strength of the flexor tendons, amount of inflammation, amount of nerve hypersensitivity, findings in gait. They should also send there treatment proposals for each of the findings that is abnormal. It is a good starting point for us. RichDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-2020621046834009772015-09-23T03:10:07.665-07:002015-09-23T03:10:07.665-07:00Thank you for your reply. I am now 4 1/2 months p...Thank you for your reply. I am now 4 1/2 months post op. I had gone to physical therapy but my therapist and I decided to stop since it was not helping my pain. In addition to the bone and cartlidge removal that I am trying to heal from, my PT said I had a neuroma affecting the 2nd and 3rd toes. I have not been using a boot and I have been trying desperately to get orthotics but my podiatrist is being difficult because the insurance is taking their time in getting payment to the doctor. And I have not had another MRI, I can't even get in to see my podiatrist, that is how difficult he is being. The foot now feels like it is getting worse and I am back to driving having to use my left foot to brake. I don't know what else to do and would appreciate any advice. Thank you so much.Jillnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-91423766419048121712015-06-18T20:44:40.637-07:002015-06-18T20:44:40.637-07:00Jill, thanks for the comment. Even though the sesa...Jill, thanks for the comment. Even though the sesamoid was removed, it can take months and months for the cartilage surgery to attempt to heal. Make sure you get a new MRI in 3-6 months to check on bone edema. You need to stay between pain levels 0-2 and that could require 3 months in the boot. You need to get an insert like the Red Sole orthotic and see if it can allow transition from cast to shoe. I like this insert because it can be modified. The transition can take 2-6 weeks, so listen to your body and go slow. You should be icing twice daily and contrast baths each evening. See if rocker shoes like Hoka One One or New Balance 928 and 1069 help. Hope this helps some. RichDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-88086985552183520122015-06-10T04:48:40.500-07:002015-06-10T04:48:40.500-07:00I am 41 and injured my foot in a car accident. Aft...I am 41 and injured my foot in a car accident. After an MRI (2 months later) my podiatrist said the tibial sesamoid was fractured and had to be removed. When he was in there he also found that the cartlidge was pretty much gone so he cleaned that up. I am 5 weeks post op. I was not given any PT or instructions other than to wiggle my toes and transition into a regular shoe. I have been trying to stay off my foot and keep it up as much as possible. At work I wear the walking boot. If I try to wear a shoe, I am good for maybe 10 minutes and then the pain becomes too much. I also find that without the walking boot I have to walk on the outside of my foot which is giving me hip pain. Should I be massaging the area or doing anything else? I do roll my foot on a frozen water bottle at night and try to move my toes when I sitting. He had told me I should be healed in 6 weeks, but I sure don't feel like another week is going to make a huge difference. I have an active daughter and we are eager to get work to life. Thank you.Jillnoreply@blogger.com