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The response to the question below was authored by Marc Mitnick DPM
sesamoiditis after bunion surgery
(Eureka California )
After bunion surgery on both feet my right foot is not healing and with a compounded cream, anti-inflammatory and new orthotics. I was told I have sesamoiditis. I still have pain and swelling in my left that I could accept
that explanation for... but my right has always felt thicker and it feels like a bony mass on the ball of my foot. Supposedly the x-rays looked fine.
My right foot does not lay flat like my left. Like the tendon is shorter and
the toes are very difficult to move. I did bump it a couple of times very hard right after surgery. It just feels different structurally.
Is there any scan like an MRI that can tell if there is something else going
on? I am afraid I have made my Dr. mad continually asking that question. He said
he knows what it is and has seen it thousands of times. I just cannot explain to
him how different the structure feels and the pain is so much worse. It is like
I did not "develop" sesamoiditis over time....it has been like that ever since
surgery. Should I get a second opinion. I am worried it will effect my employment as I am a mail carrier. Thank You!
I would tend to agree that ongoing foot problems will tend to adversely affect you as a letter carrier.
There are a few things I would have liked you to mention in your narrative. The first is how long ago you had your bunion corrected. There is acute sesamoiditis and there is chronic sesamoiditis, meaning that sesamoiditis can occur as a result of bunion surgery but how long it lasts is critical.
If you have only had it for a couple of weeks and your surgery is fairly recent, then I am not as concerned as I would be if you had your surgery months ago and the sesamoiditis has been with you for a long period of time.
The other question I would have liked answered is the type of bunion procedure that you had performed on your right foot. If it involved breaking and resetting the metatarsal bone then there is a greater incidence of sesamoiditis with these procedures than other bunion procedures. If this happens to be the case, then there is the possibility that there was some damage done to the sesamoids themselves, particularly with the saw blade used to cut bone and I am not sure how quickly, if at all, the sesamoids will heal in spite of new orthotics and anti-inflammatory medication.
The other potential problem is if you have very little fat underneath the ball of your foot to begin with. In general those with a "fatty" forefoot tend to have less issues with sesamoiditis than those who have bony feet to begin with, where you can actually feel the sesamoid bone by pressing on the bottom of the foot.
You raise the issue of an MRI. In theory it might be helpful in determining how the structures of your forefoot line up and whether there is any damage to the sesamoids or to the ligaments that attach the sesamoids to each other and to the metatarsal bone. However, if you have any hardware implanted in the bunion site, like screws or pins, that could lessen the effectiveness of the MRI.
I would sum it up this way. If the surgery was fairly recent and you have been bothered by sesamoiditis for a short time, you might ask your surgeon to send you for physical therapy in addition to wearing orthotics and taking medication
If however, your surgery was at least five or six months ago and the sesamoiditis has been present for most of that time, a second opinion may be in order by someone who is unbiased. The fact that your foot does not lay flat and I assume prior to surgery it did lay flat, is a cause for concern to me.
Marc Mitnick DPM
Johns Hopkins Medicine
University of Rochester Medical Center
American Academy of Pediatrics
Penn State Medical Center
National Institutes of Health
Columbia University Department of Rehabilitation
Stanford Health Care
Illinois Bone and Joint Institute
Mount Sinai Hospital
Institute for Chronic Pain
University of Florida Health
American Family Physician
University of Maryland Medical Center