Russell Ramblings: Pre-surgery

How we got here

[Note that this section has a number of actual pictures that may not sit easy with you. If you are squeamish, you might want to skip the pictures. I’ve put these pictures at the end of this posting so you can just stop before you get to them if you desire!]

I started having problems with my right foot in early 2018 (four years ago). For a while I have had an issue with the way that the big toe on my right foot was getting misshapen. It was believed that I had some arthritic growth at the base of that toe. I was developing a large bump under that point and could not bend my foot flat. It looked a little like the below.

[Bursitis]

But then in early 2018, it began developing an actual sore which eventually became a small open wound [see picture of my foot from 2018 at the end of this posting.] Being careful in walking, never being without shoes, etc. did not seem to relieve the issue and the wound remained. After a bout of sepsis (which may or may not have been caused by this), I eventually went to the wound care center at our local hospital. They bandaged my foot and had me wear a surgical boot for a few weeks [see picture below] and that cured the issue (at least for a while). I also switched to new orthopedic shoes which I faithfully wore.

But in 2021, all the care I had been taking only turned out to delay the issue. The sore on the bottom of my foot came back with a vengeance. [The picture at the end of this posting gives you an idea of how big the sore was.] When all the dead tissue sloughed off, I had a huge open wound on my foot. I stopped going to my local podiatrist and began seeing an orthopedic specialist.

Besides seeing him every 2-3 weeks where he cut off any dead tissue that was building up, he also gave me a prescription to get a pair of custom orthotics with inserts that helped relieve the pressure on that part of my foot. After several weeks of delay due to issues with the shoe manufacturer, I got my new shoes [see picture at the end of this posting]. That is the ONLY pair of shoes I now wear and I NEVER go anywhere without them.

The shoes (which relieve the external pressure on my foot) and every 2–3-week visits to the specialist have helped. The size of the “hole” on the bottom of my foot is definitely smaller than when I started [see final picture at bottom of posting]. But then it stabilized and refused to get smaller. So, here I am in early 2022 and more drastic action is needed. The specialist has recommended surgery that will relieve the pressure from the inside – this is known as sesamoidectomy [yes, that was a new word for me too, look it up if you like!]

He wanted to schedule my surgery the end of this month. But because my wife is having her hip replacement surgery in just a few weeks and I’ll need to be able to drive her around for a little while, we’ve had to put it off for a little while. So, I’ll see him in mid-March and get it scheduled. I’ll not be able to drive for several weeks afterwards, so that will make things interesting!

Sesamoidectomy – an anatomy lesson

So, what is a sesamoidectomy? Well, first, the “ectomy” is a suffix meaning to remove – like an appendectomy is an operation to remove the appendix. So, then we must ask, what is a sesamoid? A sesamoid is a small, round bone which is embedded in a tendon whose function is to protect the tendon as well as to provide a fulcrum that helps the associated hinge joint to have sufficient strength. Your patella (commonly called a kneecap) is the largest one. There are also sesamoid bones in your hands and feet. Of concern to me are the pair of ones at the base of each big toe.

[Sesamoid bones] [sesamoid bones2]

Because these two bones are directly behind the wound on the bottom of my foot, they are putting pressure on that spot from the inside which is contributing to the wound not healing. The plan is to remove the one to the inside of the toe as that is the closest to the wound. (Removing only of the two bones is fine as the other can still provide the fulcrum point, but if both are removed the toe flexors lose necessary leverage and can’t function, i.e., you would not be able to walk properly.)

Sesamoidectomy – What to expect

One would think that replacement of a hip like my wife will be going through would be much more “major surgery” than removal of a small pea-sized bone in my foot. Alas, while the incision in her hip will be larger, she can expect to be walking the same day, pain free, and back to normal pretty quickly. But that is not the case with my surgery.

While the length of my surgery will be about the same (1.5 hours), and the incision smaller, because of the location of the incision the recovery is much longer. I am told to expect about two weeks of staying in bed with my foot elevated, followed by perhaps four weeks of wearing a surgical boot so that I do not put pressure on the bottom of my foot or bend my toes. This will mean up to six weeks of non-driving and using a cane/walker/crutches to give adequate support once I’m allowed to walk.

[Surgical boot]

Some miscellaneous information

The good news (if one can call it that), is that despite my being diabetic [with blood sugars finally under control since starting insulin last fall], I still have good circulation in my lower extremities. Also, despite the neuropathy caused by the diabetes which means that I have no feeling in the front halves of both feet, I have taken very good care of my feet and have avoided injury (which is a problem when you can’t feel your feet). Also, I have taken such good care of the wound that I have not had any infection even though it’s been an open wound for ten months.

I’m also grateful for the availability of information on this condition and the expectation for my operation. I point to a blog written by a lady named Kim who went through this back in 2011 and posted all her updates to how things went (https://kimsfootstory.wordpress.com/).

Pictures – not for the squeamish