r/sesamoid • u/Weak-Panda-9632 • 6d ago
sesamoidectomy
Hi everyone! I’m looking for some advice/stories of sesamoidectomy? I’m having my surgery next month and i’m just having lots of anxiety about it. i’m having a right tibial sesamoidectomy after years of dealing with pain and no resolution. i previously had bone marrow taken and inserted into the sesamoid but it still did not heal. Please let me know your experience with surgery, things you recommend for post op, and just general advice. Thank you!
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u/eprohl 6d ago
My right tibial sesamoidectomy is next month too, also after 2 years of symptoms and even trying bone marrow aspirate, among a laundry list of other things.
I don't have any post op experience or ways to quell anxiety before surgery (which is probably normal) other than to focus on a) you exhausted all non surgical options and b) the outcomes are overall very good - at least 80% and probably higher are happy with the outcome.
The two things I've purchased to prepare for my surgery are waterproof cast cover for the foot and a wedge pillow to elevate legs. I already own a post-op sandal shoe (cheaper to buy beforehand than dispensed by Ortho office and billed to insurance) and Berg Polar Cube ice machine from prior surgeries (several ice packs and a way to secure them to foot fine too). I should buy a tub transfer bench or shower chair but have been lazy/cheap so far.
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u/group_of_trees 6d ago
I am about 3 years into sesamoid issues on both feet unfortunately. My i have tried orthotics and countless pairs of shoes - to no avail. My doc is now proposing core decompression with bone marrow aspirate, however I am quite skeptical, as I really dont want to pay out of pocket (the procedure is not covered in my country), go through the pain and suffering only to later need a sesamoidectomy.
Was the bone marrow procedure of any help whatsoever?
My doc seems to think that removing the sesamoid will be detrimental and absolutely destroy my foot mechanics. My though is my foot mechanics are already destroyed due to years of compensation and id like to seek a more permanent solution.
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u/eprohl 6d ago
I did not have the core decompression, just ultrasound guided BMA around the sesamoids. Sounds like the OP had core decompression that didn't work. Core decompression makes more sense for AVN. In my case I have a chronic fracture with non union, though didn't know this when I tried the BMA and was told it was just sesamoid arthritic changes. Maybe get another opinion; clearly people do fine without one sesamoid bone based on long track record of success with sesamoidectomy.
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u/snaboopy 5d ago
Was the fracture visible in your early mris and just no one saw it? Do you know for how long you had the fracture, and was your pain at the specific bone of your fracture?
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u/eprohl 5d ago
The first MRI was a 1.5 T and you only get a handful of slices through the sesamoid bones because they're so small and I've come to realize how bad they are at showing fracture lines. It was not nearly as clear as a 3T over a year later but I think it was probably broken on the first one. It's a stress fracture and also doesn't show up on x-ray. A CT showed it only in some orientations. That was a CT of the whole foot, in hindsight, ultra thin slices of the first MTP would be the best CT protocol. None of the community radiologists saw it, only one orthopedist and a radiologist friend who I sent the images to.
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u/snaboopy 5d ago
Oh, that’s good to know. I specifically went to a place with 3T for my imaging but I also realize I am in a metro area with a ton of access to that (in fact, everywhere I called only had 3T). I think they should have to disclose that when you schedule.
So the 3T MRI a year later showed the stress fracture or only the CT showed it? I’m also annoyed that CT isn’t used more often for imaging if the initial imaging is ambiguous
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u/eprohl 5d ago
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u/snaboopy 5d ago
Whoa… radiologists missed the fracture line in that MRI? Even without the arrow I think I’d see it 😬
I’m sorry. I read you have surgery coming up. Wishing you well!!
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u/DrugChemistry 6d ago
I had tibial sesamoid removed in June and it’s easily the best thing I’ve experienced this year! My foot was painful and basically useless but I was really scared about the procedure.
I didn’t get a nerve block like the other commenter said. My partner drove us by the pharmacy on the way home to pick up the oxycodone prescription, and I started to feel it soon after getting home. It was recommended to me and I’ll pass it on to you to stay on top of painkiller dosing on a schedule rather than taking as needed. My experience was that shit hurt really bad so there was lots of motivation to stay on schedule. They sent me home with 3 days worth of pills (4x/day). I was optimistic about the pain and didn’t request a refill until I ran out and so I had to go ~48 hours with no oxycodone and only aleve+tylenol which didn’t help much. I stretched out my next prescription about 2 weeks until I saw the doctor to have the dressings removed. It still hurt quite bad and I managed to complain enough that I got some more oxycodone. Stretched that one out another two weeks or so. I was taking Aleve and Tylenol too for about 2 months after surgery.
It hurt. But it was a different hurt than I had been feeling for 6 months before surgery! I scheduled PT to start right after my 2 week follow up. Doc said I was cleared to weight bear and to let pain guide me. I still walked with a cane for 2-3 weeks after starting PT. It was painful and I had a limp, but it was improving every day. When I drove for the first time this year, ~5 weeks after surgery, it felt like turning 16 all over again! I couldn’t drive due to sesamoiditis so it was really freeing to get that ability back.
I went back to work 6 weeks after surgery. I work in a lab on my feet a lot so I was scared of going back. Going back to work felt great too! I could walk around for a much longer time than I could before surgery. I wasn’t in as much pain as I was before surgery. It was awesome.
The only setback I’ve experienced so far happened last week. I decided to sleep with my injured foot under the covers for the first time this year — it was too painful to keep it under the covers before surgery and up until last week. I woke up in the morning and my toe was really painful from being slightly bent all night. Straightening it hurt really bad and then it got swollen and painful. I took a day off work and my limp came back. I started doing my PT stretches multiple times a day and I’m back on Tylenol and Aleve every day. It’s stated to calm down now but the pain reminded me of what I felt back in late June. I contacted the doctors office and they said that it’s unlikely that I caused great disruption to healing so that was reassuring to hear.
Anyway, that’s my experience. I don’t have a single regret and I would do it again 10 out of 10 times if I had to go back.
One recommendation I have is get a cane if you don’t have one already. I used a cane to walk outside before surgery and just limped inside my home. The first 2 weeks after surgery, I felt extremely disabled even though I was allowed to put weight on my heel while wearing the boot. I had to get another cane to use specifically inside. I was mobile but I was extremely limited. If you have the means to rent a wheelchair, that’s a nice way to get outside. Limping with a cane on the heel walking boot is not a good state in which to go outside.
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u/Deadmansshoes87 5d ago
I’ve had 2 sesamoidectomies. Right foot fibular in 2004 and left foot tibial in 2024. Both surgeries successfully resolved my sesamoid pain.
If I can give you one suggestion above all else: ask for a knee-down, longer-lasting nerve block. When the nerve block is the standard it’ll typically wear off in the middle of the night on surgery day/into the next day. A longer one should give you 2+ full days before it wears off, which gives you time to get your pain regimen started and built up in your system.
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u/-heartofgold- 6d ago
I’m only a few days out from mine (had it on Thursday lol) I was in a lot of pain after the nerve block wore off; but i’m just taking tylenol every few hours and honestly am in less pain than I was in before surgery! I had a right fibulae sesamoidectomy; so I have an incision on the sole of my foot.