Partial Sesamoidectomy for Fractured Sesamoid: Email Report from Patient

This patient and I communicated in 2013 over her fractured sesamoid and conservative treatment. 

Hi Richard,

You probably won’t remember me – we chatted quite a while back about my sesamoid stress fracture (see below) and you were a huge help to me! I still follow your blog religiously, and noticed someone had contacted you about outcomes from partial sesamoidectomy last week – a relatively new procedure. 

After a fair amount of conservative treatment failing me (and some impatience to get back to Ironman racing as well as being able to be on my feet for work 40+ hours a week), I saw one of Australia’s best lower limb surgeons Dr Ben Forster (might as well give him some credit over the internet), who operated.  He had planned to bone graft the sesamoid, but the bone fell to pieces once he got in there so he cleaned it up and did a partial sesamoidectomy instead, leaving about 2/3 of the (healthy) bone in tact.  He also did a (planned) Dorsiflexion Osteotomy of my 1^stMetatarsal at the same time, to decrease future risk of re-injury given my age, injury history and urge to return to long course racing.

Anyway long story short, the surgery was a huge success.  The rehab process was LONG (9 months back to running, including 6 weeks in plaster NWB’ing, 8 weeks in a boot, and many, many hours of rehab exercises and patience).  I got back to running 8km very comfortably before becoming pregnant, and have been able to maintain running up until 8 months pregnant – even with 11 exra kilos on board! My foot is not my limiting factor and I hardly ever think about it any more, it feels great, so I have full faith in a successful return to racing once the baby arrives.

Anyway I hope that my experience can help you and some of your patients with some hope on the situation.

Thanks again for your help and please never stop doing what you’re doing, your work is amazing!

Post Partial Sesamoidectomy: Email Advice

Dear Dr. Blake,

As you know from our previous emails, I had a fractured sesamoid. After going all of the treatments, I had the surgery 11 weeks ago. My doctor made a partial sesamoidectomy for the fibular sesamoid, he only took the smaller piece of the fractured sesamoid, which already has AVN.

 6 weeks after surgery, I noticed that there are some color changes in my foot and lower leg, so they made a doppler and found out there is a thrombophlebitis around my ankle. They gave me antibiotics and anti-inflammatuar drugs and also compression socks. After 1 month, i went thru the dopler again, and now there is no clot or anything just minimal chronic venous stasis on my upper legs.

 But when I dont wear compression socks and stand on it long time, my foot which i had the operation from goes red and warm, but when i elevate it, it immediately turns normal. I have swelling as well, but not very bad. I am not applying ice or heat because I'm afraid it will affect the circulation. I never iced after surgery. 

Dr Blake's comment: Typically patients who develop thrombophlebitis are on anti-coagulants for 6-9 months so yours must have been minor. The fact that you can elevate and the circulation returns to normal is great. However, you should always be wearing, minus sleeping, the compression hose for the next 6 months all the time. Since you had surgery, and the healing process goes on for the next 9 months quite actively, you should ice pack at least once a day for 10 minutes, and do one set of contrasts each evening. 

Apart from this, before the surgery I have mild halux valgus deformity with no pain. My incision is directly on that part of my foot, i mean around the bunion area, and now it hurts with touching, do you think it will go away?

Dr Blake's comment: yes, but get a Blaine's scar kit from a local pharmacy and massage the scar for 5 minutes twice daily. It should be cross frictional, across the grain of the incision, and non painful. 

I am reading a lot, but there is not much about partial sesamoidectomy, I hope the remaining part will not hurt. Do you have any experience? I am still wearing tennis shoes with custom orthotics, I don't know when I can switch to regular shoes and even to heels(if possible).

Dr Blake's comment: Surgeries of this sort can be rehabbed gradually and progressively. First you build up your walking, without limping, and without pain over level 2, up to 60 minutes with tennis shoes. Then you slowly introduce wearing of dress shoes (wide enough not to push on the scar). When you are up to 2 hours in dress flats without symptoms, than gradually begin to wear 2-3 inch heels with a dancer's pad. 

Another thing I wonder if I can feel the sesamoid by touching, because I can feel something like a bone when I touch which is more palpable than it is onthe other foot.

I'll appreciate any answer to my concerns:)

Thank you very much...

Dr Blake's comment: Sure you can touch the sesamoid since it is right under the skin. Can I ask why you decided to the partial and not complete sesamoid removal? My readers would definitely like to know what went into your decision.