Should my daughter have surgery on a toe?

Question

Dr. Janis in Central Ohio wants to remove a bone in my daughters toe. A sesamoid bone. She fractured it about 9 months ago. Its a double bone in one toe that the Dr. says we really don't need. My questions are: 1) how long will she be laid up? 2) will she be able to wear heels again? 3) is this a fairly common surgery? 4) what are the complications? 5) she is in alot of pain now; is surgery the only option?

I am asking here because....HELLO....some doctors are out to make money! I would like to hear some input from people who have had a similar surgery etc.

Answer 1

1) Only the doctor can tell you that, a small surgery like this would probably require 2-4 weeks bed rest (meaning off the foot) and regular therapy
2) Why is this really important?? Shouldn't you daughter healing correctly and having no problems walking, be the main focus? I am sure if she takes care of the wound after surgery, she can wear any shoe she desires
3) I am sure it is, ask the doctor. I assume it is fairly common. You need to talk to a podiatrist
4) I am sure if she doesn't take care of the wound after surgery she 1) won't be able to wear high heels again, 2) have problems walking 3) end up with an infection 4) possible 2nd surgery
5) probably, pain pills are highly addictive. I think surgery would be more beneficial now, than popping her full of pain killers

Answer 2

The sesamoid bones of the first metatarsal of the foot. This area is beneath the pad on the foot just proximal (closer to the ankle) to the big toe. These two bones serve to protect the tendon that flexes the toe, by protecting it from the body's weight.

Nonsurgical Treatment
Doctors prefer to begin with nonsurgical treatment. Your doctor may recommend treating the inflammation and pain of sesamoiditis with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Special padding in the shape of a J can be placed inside your shoe to ease pressure on the sesamoids as you stand and walk. You may need to limit the amount of weight placed on your foot when you're up and about. Shoes with low heels may also ease the pressure. Occasionally, doctors inject steroid medication into the soft tissues around the sesamoids to decrease the inflammation

Some doctors place a patient with a fracture in a cast for about six weeks. Afterward, the patient must wear a stiff-soled shoe until the pain goes away. The stiff sole of the shoe keeps the toe steady and prevents it from bending while you walk. Other doctors prefer not to cast fractures. Instead, they have their patients wear a stiff-soled shoe right away.

Stress fractures are a bit more complicated. If a stress fracture doesn't heal, it becomes a nonunion fracture, an extremely painful condition that can cause significant disability. If the problem isn't better in eight to 12 weeks, surgery may be needed to remove the pieces of unhealed bone. To avoid the problems of a nonunion fracture, some doctors use a cast and require patients to avoid putting any weight on the foot for up to eight weeks.

Surgery
If surgery becomes necessary, several procedures are available to treat sesamoid problems. Which one your surgeon chooses will depend on your specific condition.

Bone Removal
Your surgeon may recommend removing part or all of the sesamoid bone. When bone is removed from only one sesamoid, the other sesamoid bone can still provide a fulcrum point for the toe flexors. However, if both of the bones are taken out, the toe flexors lose necessary leverage and can't function. When this happens, the big toe will either bend up like a claw or slant severely toward the second toe. Thus, surgeons usually try to avoid taking both sesamoids out.

When a sesamoid bone is fractured in a sudden injury, surgery may be done to remove the broken pieces. To remove the sesamoid on the inside edge of the foot, an incision is made along the side of the big toe. The soft tissue is separated, taking care not to damage the nerve that runs along the inside edge of the big toe. The soft tissues enclosing the sesamoid are opened, and bone is removed. The tissues next to the sesamoid are stitched up. Then the soft tissues are laid back in place, and the skin is sewed together.

Surgery is similar for the sesamoid closer to the middle of the foot. The only difference is that the surgeon makes the incision either on the bottom of the big toe or in the web space between the big toe and the second toe.

Scraping
For patients diagnosed with stubborn plantar keratosis, surgeons generally perform surgery to scrape off the extra tissue. Your surgeon may decide to shave off only the affected part of the bone. The bottom half of the sesamoid is cut off, and the rough edges of the remaining part of the bone are filed with a special tool to leave a smooth shell. This surgery is easier on the body than procedures that completely remove the sesamoid.

Bone Graft
When patients continue to have problems with nonunion stress fractures, a bone graft may help the parts of the bone heal together. Surgeons mostly use this type of surgery for high performance athletes to keep the fulcrum point intact. The surgeon makes an incision along the inside edge of the main joint of the big toe. This exposes the sesamoid bone. The surgeon gathers small bits of bone from a nearby part of the big toe bone. The bone fragments are then packed into the unhealed area of the sesamoid. The soft tissue surrounding the sesamoid is stitched closed. Then the soft tissues are laid back in place, and the skin is sutured together.

After Surgery
After a surgical procedure to shave or remove bone, patients are generally placed in either a rigid-soled shoe or a cast for two to three weeks. Most are instructed to use crutches and to limit the weight they put on the foot during this period.

Treatment is more cautious after bone graft surgery. Patients usually wear a cast for up to four weeks. Then they wear a short walking cast for another two months, at which time active exercises can start.

About 12 weeks after surgery, surgeons begin computed tomography (CT) scans on a regular basis to keep track of how the bone graft is healing. The CT scan uses X-rays that are interpreted by a powerful computer to create images that appear as slices through the body. With a CT scan the surgeon can see the bones of the sesamoid better to determine if it is healing.


I have put some links below that may help with your decision.

Answer 3

I would be sure to get every question of your answered by the doctor before procedding in surgery

Answer 4

Why are you asking us? These are questions for the doctor or get a second opioion from another professional.

Answer 5

i think u should go on line look up the doctor/his info stuff like that if she is in pain i would do hat ever i can if she was my daughter

Answer 6

if the DOCTOR told that needs to ahve the surgery..then she needs to have the surgery. i know its sad to know that ur daughter will b going thru this but...its for her own good.

Answer 7

Hellllllo? why not ask the doctor these questions and maybe get a second or third opinion?

Answer 8

Yes do it for your daughter's sake and yeah...ask the doctor this, not us :)

Answer 9

Ouch! My back hurts