Removal of Lateral Sesamoid in Foot (Avascular Necrosis/Stress Fracture of the Lateral Sesamoid)

Several of you have commented that you would like more information about treating a fractured/dying sesamoid bone with surgery. I have decided to go through with surgery, myself, and will be updating everyone through this blog. My surgery is tomorrow (July 10).



Here is what I know so far:

Condition

Stress Fracture on Lateral Sesamoid in my left foot 

(One doctor said this is a form of avascular necrosis. The bone has been decaying and fragments of it are finding their way to other parts of my foot).

It is more common for the medial sesamoid to have a stress fracture than the lateral sesamoid.

What is a Sesamoid?

A sesamoid bone is a bone embedded with a tendon. Your kneecap (patella) is an example of a sesamoid. It helps give movement to other bones.




Onset

My doctor said with this particular bone, a stress fracture usually occurs over a long period of time - lots of jumping, running, etc., rather than from a specific event. For me, this was probably a combination of things like drill team in high school and P90X Plyometrics. 

Symptoms

The pain became gradually intense/severe with burning and stinging sensations. The pain dissipated with anti-inflammatories and rest, and remained a dull, aching pain for three years. Any light to moderate physical exercise would cause more intense and prolonged pain. 

The pain wraps around the side of my foot. I feel a majority of the pain on the ball of my foot, but sometimes I feel it in my big toe and even on the top of my foot.

Conservative Treatment

For three years I have tried treating my injury with anti-inflammatories, refraining from physical activity, and wearing orthotics. Sometimes these methods would alleviate the pain, but it has never gone away and still causes me pain every day. 

Further Treatment (Surgery)

After three years of pain and several different opinions, I have decided to go through with surgery. Here is what I know about the surgery as of now:

They will remove my lateral sesamoid and re-route the tendons that went over that bone to go over the medial sesamoid.

The surgery is outpatient surgery. I will receive anesthesia and will be on my stomach for the procedure. They will make a small incision on the ball of my foot. The surgery should last about an hour.

Pain medications prescribed: Hydrocodone for pain and Phenergan for nausea.

Recovery

I will be on a knee-roller (crutches are also an option) for 4-6 weeks then a walking boot for 4-6 weeks. 


I will post again with more updates hopefully a day or two after surgery. 

Please feel free to leave any comments or questions you may have! I have greatly benefitted from everyone's feedback and support. It is very helpful to share stories with others who have similar pain. Together we will find healing!






Comments

  1. LikestoreadSeptember 5, 2018 at 9:56 AM

    Hi I'm wondering how your surgery went? I have a possibly dying sesamoid bone and liked the fact that your doctor said it would dissolve if you wait it out. My doctor had never heard of that, but I've seen it several times informally online on blogs, etc. I'm at the point where I"m wearing an immobilizing boot to see if I can heal a torn ligament and revive the sesamoid bone, if that's possible. Would love to hear how things went for you. Thanks...

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    Replies
    1. TaylorSeptember 6, 2018 at 7:48 AM

      Hi thanks for your comment. My surgery went really well and my foot is doing great. The recovery was a little tough - I had an infection that made it take a while longer to heal up correctly, but after that, no complaints! My foot pops a little bit in the mornings when I wake up and walk around the house but then it feels like a normal foot. I avoid high impact exercise. Overall I'm super glad I went through with the surgery!

      Delete
    2. LikestoreadSeptember 10, 2018 at 2:16 PM

      Thanks for writing back. Good to know it went well for you. I had another doctor recommend surgery but am still in the boot for another 3 weeks to try and see if I make any progress. You mentioned your doctor said it could dissolve on it's own. I asked all of the doctors I've seen but none of them know about that. Obviously that didn't happen for you, but how long did you wait to see if it would dissolve on it's own? thanks again--Meg

      Delete
    3. TaylorSeptember 11, 2018 at 7:42 AM

      It was so long ago I don't even remember him saying that! Ha. I waited a long time. Maybe a year and a half? Two years? I had a few MRI's/xrays and I don't think the size ever changed. I had never heard of it either. Sorry you're dealing with this! I can offer you hope on the other side of surgery. So glad I went through with it!

      Delete
  2. UnknownAugust 14, 2019 at 10:08 AM

    Thank you for all the information you have been sharing. I've been pouring over your Avascular Necrosis post and the numerous corresponding comments. Then I found that you'd actually had the surgery to excise the sesamoid. Great to know it has worked for you. How are you doing now a few years out? My own story is similar and I saw it reflected back in all the anxious comments on your blog. Ball of foot pain - misdiagnosed as other things for several months - pain killers to mask the injury and continued damage done - then finally a podiatrist visit that diagnosed sesamoiditis. Upon learning this I found Dr. Richard Blake's blog and pushed for an MRI which showed AVN. Now headed toward bone stimulation to try and save things. I'm willing to put a year into the conservative measures if they show signs of helping at all. But I'm definitely more heartened by hearing your surgery success story and others that were listed in the comments section. I'll report back on how my own journey goes. Thanks again for your openness and willing to share personal trials and tribulations. - Andy

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