Has anyone had a sesamoidectomy (sesamoid removed)?

I was hoping some of you that may have experienced nerve issues POST-SURGERY from sesamoidectomy could help share your story? I'm having a hard time with recovery. I'm frustrated that I'm not healing as fast as I should be at this point. I had my non-union fractured tibial sesamoid removed from my right foot on 11/15/18 after 23 months of pain/severe pain. The surgery was done on the inside of my foot near the bunion area for healing to go faster. I tried everything non-surgically to repair it, to no avail, including a bone growth stimulator for 6 months. The best sesamoid surgeon in my area removed it.

It has now been exactly 5 MONTHS AFTER my surgery and I am still in the same amount of pain as I was 2 months after surgery. Yes my range of motion is not back completely and expected this, but most of my problems are nerve-related that flare through my entire big toe. Any amount of walking causes pain all the time in my big toe area. I just tried going back to light working out (treadmill, elliptical, etc...), but feel this is all my foot can handle. As a woman, I still can't wear any shoe that is not completely flat (not even a 1 inch boot) unless I'm prepared for pain as I walk and more throbbing pain for the next 24 hours. I can't even consider a heel that is 2 inches high and may never be able to. I can't walk without pain even in the best running shoes. I am just trying to figure out if this is normal in the healing process after 5 months. Am I expecting too much from my foot this soon after surgery or is there now another problem?? What should I be doing to help my foot heal with this nerve issue? I already had 1 cortisone injection in the area and I don't feel like it did much to alleviate the pain. Any advice would be helpful...

Hi Julie,

I viewed your blog and wanted to hear more updates since last August at the 5 week mark post surgery. Any insights? When did you get back to working out and being active?

I've been meaning to find the time to write a blog post for forever. I'm doing great these days. Never ended up getting surgery. Held out for four years, with things getting better for a while, and then worse again.. repeat, repeat. I was on crutches more months than not for four years, and never would have been able to survive without the support of family. The cycles would last 6-8 months where I would be on crutches. I got to where I was playing soccer again, and then bam, back to square one. Now days I'm back playing soccer again, and I'm confident that I'm pretty much done with this injury. I have learned exactly what my limits are and when to stop. When things would get really flared up, I would have to keep my foot completely still. Even the vibration from being in a car or not positioning my foot correctly would make things get worse.

I believe my problem was likely chronic tendonitis/tendonosis. I do have an elongated, bipartite sesamoid bone. It may be rubbing up on the tendon, but I don't think the problem is one piece of the bipartite bone rubbing up against the other piece of bipartite bone.

You can see on my other foot that despite my bone not being bipartite, it looks like it is in two pieces, they are just fused together. Therefore, I think my bipartite sesamoid bone was likely once also fused together, and the bone probably got knocked loose into two pieces at some point or another, beginning my problems.

Long story short, anti-inflammatories saved me. I never used to take things like alleve, because I thought they were more of a mask for the pain while you ended up actually doing more damage to yourself while not feeling it. Not true in my case. As soon as I started taking anti-inflammatories, it cleared up quick. But pharmaceutical anti-inflammatories are very unhealthy and shouldn't be taken for any extended period of time. These days I'll take some curcumin (the active ingredient of turmeric) pills called Meriva that I heard about from Dr. Rhonda Patrick. They are legit! I have listened to probably 30 hours of Dr. Rhonda Patrick on different podcasts and whatnot, and I find her to be a very credible, good source of information. Apparently you have to take curcumin/turmeric in a special way to get it to absorb. Taking it with a source of piperine such as black pepper increases the absorption of curcumin 2000% apparently. But Rhonda Patrick recommends taking curcumin in phospholipid form instead. Apparently it absorbs well that way too. Dr Patrick said something about phospholipid form being good for delivery to your cells, and the mechanism/theory making sense to her. She recommends taking the Mervia SF (sustained release) pills. You can take at least 1 gram of curcumin a day safely. I'll take a whole gram all at once. Anyhow, enough about curcumin.. getting back to my foot.. One other really weird thing is that I was so terrified of walking barefoot, that I never did it for years. In the beginning walking barefoot was a really bad idea I do believe. But years later, for a little while, I found the best thing I could do was walk in a sock of a certain medium thickness. These days a regular shoe tends to be best. I wore orthotic shoes for so long, that they started to become part of the problem. This is common apparently from the accounts that I have read. Many people go full circle with custom orthotics and end up going back to a simple gel insert, etc. I think orthotics can often be a short term solution, but you often need to get back to something more natural if at all possible.

Hi, can I ask what you ended up doing? I'm trying to decide what to do about surgery. Thanks

Hi there. How did the surgery go? I deciding what to do?. Thanks for your help

Hi sad runner. I know your post was a long time ago, I'm interested what you ended up doing? I'm going through the same thing now and deciding if I should have surgery or not.

How is your foot? Mine is both feet.

Thanks

Hey I know this was seven years ago but I just recently had a Sesamoid removal surgery in October of 2019. I was walking on the beach almost a year before that and due to my feet already being flat I miss stepped and heard snapping. I had pain for a while of course but I thought I had just pulled/strained my foot (which isn’t uncommon for me). As time went on the pain traveled up my leg which really brought together the fact that every tendon and ligament in your body is connected and important. At some point I felt like I might Charley horse and pull something inside my calf, I then went to a foot doctor near me (Washington DC) and received a boot. I was told that it was either cortisone shots or stroud surgery if the boot wasn’t successful, and it wasn’t I had walked too long ignoring my pain and surgery was my last resort. So now it’s 2021 and I am 100% walking better, I am able and still do go to work on my feet for hours in the day. It’s just this tension that I wish would be rid from my life. I have to stretch and sometimes I feel like my feet hurt in the shower, I have to get used to water. My calf will eventually act up and it’s been acting up lately and I’m so very scared that the ligaments in my leg will snap or go into lock and I won’t be able to articulate to myself how to help me. I hate this. I wish there was another way and I wish I didn’t have to go through this even tho I was worse off without surgery. I wish I knew to be careful when I was younger I’ve been so oblivious to myself I guess now I have routine out of fear and the need for my own comfort.. if there are any solutions or positive feedbacks please do respond yes. Is this pain forever? Also my big toe clicks a bunch when I bend it.

How do you feel now? I got mine in the exact same place for surgery and everything in 2020

***2020 sorry

Hi i am a semi pro footballer in the uk, aged 22, i recently had sesamoiditis that escalated to osteonecrosis in both medial sesamoids located on both feet, that kept me out for 7 months, with measures such as steroid injections and immobilisation not working, so surgery on both feet was essentially my only option. i had surgery on one foot with a 7 week gap in between, to give the operated foot time to progress before proceeding with the next, most studies i have seen are optimistic to returning to full recovery, but i have seen scatter of information indicating possible problems with regards to biomechanics when returning to sport which could increase risk of injury, but i am not sure if this is a general risk factor or dependent on the individual? With regards to my current progress, i am on week 7 post op on the right foot, with scheduled op for left, right foot is still stiff and i would say it would be no where near capable to currently bear running.

Hello mate , I’m from Birmingham , play recreational football had this prob for a few years , scared to get the op done due to horror stories .I had one scan that said avescular necrosis another saying a bipartite fracture .

How you feeling now , hope you back playing a good standard , give me an update if you can would appreciate it

Cheers

Tom

One thing to remember if you are looking for help in deciding. When someone says "do not do it", they are coming to you as somebody who had a bad outcome. Far and away most people with sesamoiditis and sesamoid fractures get better with conservative care. You do not hear from them. Of the people who get a sesamoidectomy most of them get better, you do not hear from them. The other thing that might be easy to overlook reading through these posts is to remember that the sesamoid bone in most cases does not heal. But the patient still gets better. We call this "clinically" better, but not "radiographically" better. Incidental sesamoid fractures from the past are seen on xray all the time. Patient's are interested in not having pain, so they are more interested as to whether there clinically better or not. This sesamoid bone has very little blood flow and has a very difficult time healing to the other piece. Whether it does or does not is not as relevant as whether you have pain or not. Consistent pain failing conservative care with no healing makes surgery a little bit easier decision. Be careful if someone tells you have to have surgery because the sesamoid did not heal together. That does not matter. It only matters if you still have pain. Most of the time the sesamoid does not heal on x-ray. Likely that gap is filling in with fibrous tissue or something else and if you end up not having pain well that is great. You do not have to have surgery because it did not heal. It is not an unstable fracture like, say, your leg. Its all driven by your symptoms, response to treatment and expectations (very high if a runner!).

Hi mate, I’d be interested to hear how your post operation recovery went. It sounds like I’m in a similar position to you. I’m 23, from the UK and extremely active and looking to advance further with sports.
At the moment, I’m able to do most exercise and manage the sesamoid fracture I have in my right foot. However, with MMA, I feel the pain the most and it flares up enough for me to stop what I’m doing and rest for a few days.

It would be really great to hear how you’re doing!

There have been studies showing good results from electro shockwave therapy ESWT for sesamoid issues. I’d look into that as it is relatively cheap with a low risk of complications, before looking at a surgical option.

Just to echo this post, this has been my experience as someone who has suffered with sesamoid issues including osteonecrosis.
“Healing” isn’t as relevant as I thought in the beginning. A good outcome is achieved by focusing on reducing the symptoms themselves and this can be done well through non-surgical means. It can be better for a runner to avoid surgery on the tendon which contains the sesamoid bones, and focus on reducing loading through the joint and reducing the inflammation.

My story began in December 2018, I was playing amateur basketball, wearing inappropriate running sneakers as opposed to basketball shoes. I noticed during the game my shoe had torn but kept playing on as we were short on player numbers. I don’t recall any specific injury occurring during the game but the ball of my foot ached the following day. I went on a long journey of trying every conservative treatment I could find. To no avail, it progressively got worse and I ended up seeing 2 different orthopaedic surgeons who recommended a sesamoidectomy as an option. In April 2020 I had the medial sesamoid removed.

The first 12 months or so was okay, I was back on the treadmill running within a few months. Unfortunately, things started to deteriorate and I now experience other issues which sports doctors and podiatrists have explained is due to the change in biomechanics and removal of the sesamoid. It's tender where the bone was removed, pressure on that area while walking can be painful, the arch and FHL tendon are weaker and I don't have the same power through my foot that I used to have. It feels like the FHL is constantly stretched like a tight rubber band. For now my treatment consists of custom orthotics (to support the arch and offload the ball of foot) which is frustrating because it's what I had pre-surgery and I was hopeful the surgery would alleviate this need. I also do a regime of intrinsic foot exercises but have not experienced much improvement through this.

I'm grateful that I can still go about daily life, I know many people suffer worse, but it can be uncomfortable and I cannot do the active sports that I used to love. So a word of warning, once the sesamoidectomy is done, there is no going back. Although this is a tiny bone in your body, it is VERY important in the biomechanics of your foot. If your scans are showing bi-partite, this is usually totally normal and not a reason to have the bone removed. Also, it's important to know that the advice you get will depend on which specialist or doctor you see. In my experience, if you see a physiotherapist they will recommend strengthening exercises and massage. If you see a podiatrist they will recommend orthotics. If you see a Surgeon, guess what they will recommend? So it's important to be careful who you go to see and why.

The surgeon told me that 'well you've tried conservative treatment for 18 months so it makes sense to resort to surgery'. In hindsight this is not a good enough reason as surgery brings the risk of making it worse. I would not have had the surgery done as it has caused issues that probably will never resolve now whereas previously I could have persisted further with non-surgical treatment. I will post again a long list of conservative measure you can try.

I hope that helps you and reach out to me for more information, or if you've had the surgery too, let me know what has helped you post-op.

Sesamoid and ball of foot pain. What you can do about it, my experience, and what the experts may recommend.

See a podiatrist - This may sound obvious but I didn't have much experience with the medical industry so I wasn't sure who to see first. My first appointment was with a Physio but I would recommend instead a Podiatrist because they specialise in foot biomechanics.

Custom orthotics - expensive I know but this is probably the most important thing you can do. You need to offload the area of pain and support your arch. I have had some terrible orthotics made that are simply unwearable as they make the pain worse, keep going back to your podiatrist (or find a new one) until it's perfect for you.

Hoka shoes - the rocker sole, wide toe box and cushioning reduces load in your forefoot. Any shoes with a high heel is out.

Carbon fibre insoles - i didn't try these but theory is the same as Spica taping which limits the bend of your 1st MTP joint.

Strengthening - a million different exercises you can try. ask your podiatrist but be wary not to do ones that place extra pressure on your ball of foot, specifically 1st MTP joint (big toe joint).

Stretching - I was never sure whether to stretch, strengthen or rest. It felt good for me so i regularly stretched and foam rolled my foot and calf. I think rest in the first few days is important but you need to get moving again to preserve muscle strength.

Ibuprofen gel - did nothing for me

NSAID - did nothing other than upset my stomach

Tiger balm - helped a little when it's really sore

Massage with physio cream - always helps a little in the short term

Stay off hard floors

Here are some more experimental therapies that I came across. I have not tried them all but I think it's worth a go if it helps you avoid surgery.

Bone stimulation

Shockwave therapy

Platelet rich injections

Cortisone injections - helped for 4 weeks then pain returned. Apparently repeated use is not recommended.

Acupuncture - did not help me

Wear a boot - I did this for 4 weeks as a last resort prior to surgery. I was told it's an inflammation issue so it made sense to totally offload it however I think it actually made things worse because the joint is not moving and your foot muscles deteriorate. Not recommended.

ESWT - heard good things about this

Laser therapy

Despite all this, if you are thinking in terms of surgery, rather than excise the bone, think of ways you can preserve the joint. I have come across examples of bone grafting which have been successful, albeit in small patient sample numbers.

I hope this list helps you on your journey to foot pain relief. Feel free to suggest others and I will add it to the list.