Week 9 Status Update

At the 5 &1/2 week mark, I went back to working in the office. Living in New York, I ride the subway to work and I was very nervous about commuting. It's hard enough when you're able bodied, much less when your balance is somewhat comprised. My boss, who has been extremely flexible throughout was fine if I came in later and worked late in order to avoid the rush hour commuter traffic. Equipped with my cane, I found the commute to be better than I expected. I earned a few sympathy seats from my fellow passengers and noticed how people really get out of your way when they see you have a cane. On the other  hand, plenty of people do NOT look where they walk which can be problematic for everyone. Reading while you walk is an accident waiting to happen!

So, from week 6 to week 9 (where I am currently) I've started walking more and more. The longest I've walked is a mile and a half. I have to say, the walking has been going pretty well and pain-free. My feet will feel fatigued, my legs hurt and afterwards my foot feels more swollen, but overall, it hasn't been problematic. I started PT at week 7 and we focus on bending and stretching the big toe. I do seated and standing relevees, seated toe flexes, dooming of the toes, among other exercises. Because that foot had been dormant for so many weeks, I have to stretch other parts to get my total foot mobility back. The therapist measures the toe flexion each visit and it started at 30 degrees and as of the last visit it measured around 75! I still have a ways to go and other milestones to meet. For example, out of curiosity I attempted to do a plank position and soon realized that wasn't in the cards for a while. I'm not sure when I'll be able to wear footwear other than sneakers, again. I kept my gym membership on freeze so I can focus on PT and doing the exercises at home. There are days when the foot will bother more than others. It tends to be the day after I've done a lot of walking. My PT tells me to keep icing it, which I admit I haven't been diligent about.

By the way, make sure your PT knows feet! I'm lucky enough to have found a place where 50% of the clientele are dancers, whose feet are their livelihood. The physical therapists are very attentive and in tune with  the intricacies of the feet and their impact on the rest of the body. Shout out to Westside Dance Physical Therapy!

Recap and the 6 week follow-up visit

Obviously, I've been seriously slacking in the blog post arena, so I will attempt to cover the past 7 weeks of recovery! Let's start with a brief re-cap; after my first check-up at the 15 day mark, I started wearing the DARCO surgical sandal which gave me more mobility.

They said it takes about 25% of the pressure off of the foot. It's super comfortable so you feel confident walking in it. However, I didn't feel comfortable rolling through when I pushed off on that foot so I still did the pirate walk for a few weeks. At this point, I was still working from home, so my walking was limited to getting around my apartment and an evening stroll to the supermarket or local deli. I purchased a cane online. if you live in an urban area, definitely get a cane. It does provide support but it also signals to the people around you that you're a slow walker for a good reason. On the flip side, it also signals that you are somewhat vulnerable, so take extra precaution when walking around and know who is around at all times. Preferably, don't walk alone. Living in NYC for 15 years, this is the most vulnerable that I ever felt.

These photos are at the 3 weeks mark. I was able to take the wrap/bandage off and shower without plastic on for the first time!

 I went back for another follow-up at the 6 week mark. This time I saw the surgeon, who at the 2 week mark was on vacation. He assured me that the surgery was textbook, he only took out the affected, lateral sesamoid. He started flexing my big toe back and forth, breaking up the scar tissue and I thought I was going to cry from the pain. Seriously, this was by far the worst pain I've ever felt, period. He said I needed to start physical therapy to get my flexibility back in the big toe and recommended that I go 2-3x a week for 10-12 weeks. Yowza! He said that it will be up to six months before the area is totally settled and that I should continue to wear pads under my foot(Hapads). Also, he said get out of the surgical sandal and start wearing sneakers to get my toe mobility back. When I asked about going to the gym he said I could start doing some light cardio (riding a stationary bike) in a few weeks if I wanted to.

Day 14 - First Follow-Up

I went for my first follow-up visit on Day 15. I was very excited to have my wrap removed and see what my foot looked like. It had been two whole weeks since I had seen it and couldn't wait to check out the incisions. To my suprise, it didn't look that bad. I had seen some horrible photos online and was prepared for some major black and blue but there was minimal bruising and the swelling had gone done quite a bit. They took the sutures out which was pretty painless, cleaned the incisions, covered with surgical steri-strips and re-bandaged. I was told one more week of wearing the bandage before I can take it off for good. I graduated to a Darco surgical sandal. This lovely shoe will be my daily footwear for the next 6 weeks. I was told I could walk around more, start to put pressure on it, but not to exert direct pressure on the forefoot and no bending.

Day 11 Post-Op

Day 11 of keeping my foot elevated 80% of the day (yes, 80%) above my heart. It's not ideal as you can imagine but, I know it's time limited and hey, when else can you just lie around and not feel guilty about it? Normally, I would be running around, trying to fit this and that in my days and stressing myself out as a result. Forced bed/couch rest eliminates my options. I can a) catch up on the many books on my nightstand. b) Catch up on some TV shows I've been meaning to check out. Downton Abbey, btw, is the bomb! c) Start and update a blog for fellow seisamoidectomy candidates. As it turns out, I'm extremely fortunate in that my job as a research librarian for a consulting firm, allows me the opportunity to work from home. As such I've started back to work on Day 5 post-op. It hasn't hurt that the weather has been super crappy...rainy and dreary all week. I finished up my pain meds on Day 8 and seeing that the pain is minimal, I haven't asked for more. I've been putting more weight on it and am able to walk around some. It's not fun, as my surgical boot gives me a good inch over my other leg and when I walk, it's more of a Frankenstein-type of stride. Plus, if I push it and stay on my feet too long, they start talking to me and I know it's time to recline. Crutches help me get around but, but at a cost. My hands, forearms and sometimes my back suffer as a result, so I alternate between crutching around or doing the Frankenstein shuffle. M first follow-up visit is this Thursday. I'm excited and nervous to see that my foot will look like and find out what's next on this recovery journey. Initially I was told that after 2 weeks of elevating, I'll graduate to a surgical sandal and hopefully that will allow me to be more mobile.

The immediate aftermath

I checked out of the hospital around 12:30 after having proven that I can eat some food without getting nauseous and can maneuver my new crutches. They wheel me into the backseat of my boyfriend's car, prop my foot up on two pillows and away we go to focus on my recovery. I was prescribed Percocet, 2 pills every 4-6 hours and ibuprofen every 4-6 hours for the first three days post-op. So far, at no point has the pain been unbearable. I've had some intermittent pain, where my foot feels like it's throbbing, but luckily, it goes away within minutes. At three days post-op I was able to put all my weight on that foot, although I tried to keep the weight on the heel.

My toes look normal!

This was taken the day after surgery. So far I can feel all of my toes! This may not sound like a big deal, but one of the risks of a sesamoidectomy is that your big toe will go numb. So far, so good.

The week leading up to the surgery, I wanted to be as prepared as possible knowing that I wouldn't be able to walk very much, if at all, for some time. I compare it to the feeling you get when you know you're going to be away traveling for awhile. You want to make sure the house is clean and your shelves are stocked with everything you might need; food, toilet paper, tooth paste, etc. I was told to be at the hospital at 6 am, Wednesday morning. They called me up to fill out some basic paperwork, give me my wrist band, etc. About 5 minutes after that I was called back to begin the prep. First they had me pee in a cup (pregnancy test), then I changed into my paper bloomer shorts and hospital gown while I waited comfortably on a bed watching the morning news shows. Nurse after nurse came by asking my name, the correct spelling, DOB, which foot is getting operated on, etc. One sweet nurse came by to start my IV - wow, had no idea how painful this would be -- after three attempts, she finally got it in. My boyfriend came back to wait with me and keep my mind off of what was about to happen. Finally, the doctor comes, initials my wrist-band, initials my foot and 5 minutes later, I'm whisked off to the OR. They took my glasses off by this point, so I'm walking into a blur of sorts, but I can make out that it's a large room, big lights overhead, 3-4 people in there setting up with what seemed like a lot of tools. I'm asked to lie down on the table and I literally lie down, the anesthesiologist tells me she is going to do something and within 30 seconds I'm out. Don't remember anything after that point until I wake up about 2 hours later.

How the sesamoidectomy came to be

I've always been fairly active, cheerleader in high school, a dancer in grade school and a gym rat from age 17 to present (just had my 39th birthday). About 8 years ago, I started to notice something on the ball of my right foot whenever I worked out. It wasn't painful; it felt more like a slight bulge or bruise and was just something I felt like I wanted to avoid. Over the years I had consulted with 2 podiatrists and a perdothist, each of whom prescribed custom made orthotics and each of whom told me why the last pair I had was no good. I was told I had plantar fasticiis (probably true) and then sesamoiditis for which another pair of orthotics was made. Finally in 2009, it was recommended that I visit Dr. Thomas Novella, a DPM in NYC. I was told he looks at the whole scenario - foot, lifestyle, in considering how to best treat each patient. I was curious to hear what he would recommend for me and hopeful for a successful outcome. After hearing my history and taking x-ray's, Dr. Novella suggested we get an MRI for more clarity. The MRI showed that one of my sesamoid bones had died - avascular necrosis or AVN of the lateral sesamoid. He explained that the bone no longer received blood, that the supply had been cut off. The treatment of choice for this is surgery and I was referred to Dr. William Hamilton. I saw Dr. Hamilton shortly after and he said we have good news and bad news. I held off - I certainly didn't want surgery, I didn't want any down time and the doctor didn't take my insurance. Surely, I thought, there has to be another way. Fast forward 2 & 1/2 years later and after getting two more opinions, I decided to go for it - have the lateral sesamoid bone removed. Two days ago, May 2nd, I had a sesamoidectomy at Hospital for Special Surgery with Dr. Jonathan Deland.

So, I went and had a sesamoidectomy.

If you're reading this blog, you've probably spent hours researching sesamoidectomies or sesamoid removal contemplating whether or not it's the right decision for you. I've experienced sesamoid pain for close to 8 years. Two and a half years ago I had an MRI and was diagnosed with Avascular Necrosis (AVN) of the lateral sesamoid in my right foot and it was recommended that I have the bone removed. No one wants to rush into surgery, much less for a procedure such as this with relatively little information available post-operation. I would scour the internet looking for success stories or some vote of confidence to help sway my decision. Instead, I mostly found the horror stories of complications and/or incomplete blogs... So, I'm throwing my hat into the blogosphere to document my recovery both short-term and long, in the hope of helping others decide if a sesamoidectomy is the right decision for them.