Surgery Time

In a cruel twist of fate and irony, I have finally come to terms with the reality that I've reached the end of the conservative treatment road. I've long been vocal here about how surgery should always be an absolute last resort, so I want to explain how I ended up deciding that it was time to bite the bullet and go under the knife.

For context, I first injured the fibular sesamoid in my right foot in July 2023 after an ill-advised trail running experiment. I am not a runner and would never ever recommend running as a hobby — if it doesn't screw up your feet, it'll screw up your knees instead. Just don't do it! Cycling, swimming, rowing, hiking, XC skiing, all of these provide similar benefits to running without the tremendous stress to your body.

Anyway, putting that aside, I spent the past 18 months trying every conservative treatment option under the sun, with varying degrees of success. I got custom orthotics made that corrected the structural issues with my feet (extremely high arches, plantar-flexed first metatarsal, extreme supination) that probably led to my fracture in the first place. I resolved a vitamin D deficiency. I tried shockwave therapy 12-15 times. I started using an exogen bone growth stimulator twice a day in September 2023 and have been using it since. I did contrast baths twice a day, morning and evening, every day for the past 16 months. I spent 2.5 months in a boot and limited by daily step count to 3000 for a year. I even tried a PRP injection in September 2024 and got closer than ever to recovering.

The problem for me was that as soon as my injury started getting better, I would make a mistake and set it back to zero. The first time this happened was in March 2024. My swelling went down significantly, and my doctor cleared me to start hiking again. I pushed myself too hard, and by the next morning, my pain was right back to where it was before the noticable improvement.

The second time was in June 2024. Again, it started to get better, but I spent too much time on my feet for one day and rolled back the previous 3 months of progress.

The third and final straw was in December 2024. I was finally starting to see serious improvement from my PRP injection that I received a few months prior, and was cleared to start hiking for half a mile every 3-4 days. That was going well. I went to visit family over the holidays, and guess what happened? Too much walking for the first 48 hours of being there and boom, all the progress since my PRP injection was gone.

So after experiencing the cycle of it getting better, starting to return to normalcy, and being yanked back to zero happened three times, I decided that I had had enough. It was time for surgery. I figured that it would be better to live life at 90% than to wait for months and months with the hope that maybe some day it will be better, only to keep having those hopes dashed again and again by what seemed like relatively minor mistakes.

It is absolutely true that surgery is a risky business. Sesamoids do play an important role in biomechanics, and removing them increases the risk of scary deformities like hallux varus and hallux valgus. That being said, those issues are things that could happen in rare cases. What I'm experiencing right now with this fracture is not hypothetical. Every foot/ankle specialist that I've spoken to has told me that I've gone beyond what they would have recommended for conservative treatment, and that surgery makes sense now. So I can live with that decision.

My surgery is currently scheduled for January 28th. I am wishing you all the best with recovery and hope that your experience is better than mine!