It's so hard sometimes on when and how to treat subungual exostosis. In some cases, surgery is the best option. I know I love my minimally invasove approach which works a treat to get people back their feet fast with little interruption to their lives. Hopefully your patient finds a similar outcome.

No problem. All the best with your procedure and the recovery! Remember, it gets better every day and week.

Hi, It really depends on the patient's response. Traditionally you will undertake one 0.5mL injection to each site, test for ongoing pain or a "anaesthetic like-response" and if no discomfort/tenderness, you don't need to reinject. If there is tenderness, a further 0.5mL is injected. Repeat that up to a total of 3 injections per point. Typically I find for some stubborn conditions I am injecting 80% of spots twice but only have 10%(maybe 3 or 4) that need injecting the 3rd time. I always buffer the glucose with bicarbonate. Thanks for your comment!

@ thanks so much for expertise! Look forward to the course

5% glucose with bicarbonate buffer is my go to for this technique. No LA required and in fact it will affect how you undertake this protocol. I typically don't block with LA but I do use a lot of high powered laser therapy to decrease hypersensitivity if required before starting injections. For the buffer, Sodium Bicarbonate 8.4% is used. I use 5mL per 1L or diluted as appropriate to the volume you are using. 30g needles is corect and I do 3-5 sessions with 5-7 days between them.

@ thank you so much! Have been using shockwave and laser with minimal response as yet so may try this technique. Thank you again

Hi! Following a neurectomy, it's common to experience some residual swelling or firmness around the surgical site. What you’re describing-a hard, lumpy sensation-could be due to post-surgical scar tissue or localised swelling as the tissues are healing. This can sometimes feel rubbery or dense as the body adjusts. In most cases, these sensations should gradually improve over the coming weeks or months, but everyone’s healing timeline is different. Gentle massage, recommended exercises, silicone based scar cream, a steroid injection or other techniques suggested by your healthcare provider may assist with scar flexibility. Since I can only provide general information, I strongly recommend discussing this with your specialist or surgeon, who can provide specific advice based on your recovery progress. Good luck!

When considering a sesamoidectomy for sesamoiditis, it’s essential to weigh the potential benefits and risks carefully. Sesamoiditis, or inflammation of the sesamoid bones under the big toe, can cause persistent pain, but surgery may only be suggested when conservative treatments (like orthotics, activity modification, physical therapy, or injections) haven't provided relief. A sesamoidectomy does carry risks, such as changes in toe alignment, reduced toe function, stiffness, or prolonged healing. Some people experience relief and improved function post-surgery, while others may have lingering issues. It’s a complex decision, and ultimately, only a specialist who knows your case well can help weigh your specific risks against the potential for improvement. Seeking a second opinion might also provide valuable insight as you make this decision.

After a full medial sesamoidectomy, the time it takes to walk with minimal or no pain varies by individual and depends on factors such as your healing rate, adherence to post-op care, and rehabilitation. Generally, most patients can begin walking with reduced pain after about 1-3 months, but a full return to pain-free walking may take several months. The initial recovery period often includes minimal weight-bearing for 2-4 weeks, followed by graduated weight-bearing in a supportive shoe or boot. Physical therapy may also help restore strength and mobility, aiding a smoother transition back to normal walking. Since recovery can vary widely, your specialist is best positioned to provide an estimated timeline based on your specific condition and progress.

It’s completely understandable to feel frustrated with post-surgical pain, especially during those early days. Recovery can be tough, and pain after a sesamoidectomy is often more intense than expected, particularly in the first week. This is partly because the foot is a highly sensitive area with many nerve endings, and surgery disrupts tissues that bear weight. Pain usually begins to ease by the end of the first week, and you might start to feel gradual improvements. Swelling, bruising, and sensitivity can persist for weeks, so keeping your foot elevated, limiting movement, and following your pain management plan can make a difference. Don’t hesitate to check in with your doctor if your pain feels unmanageable-they may be able to adjust your care plan to help. Hang in there; the first days are often the hardest, and things should start to improve soon.

A slow-growing, nail bed growth that disrupts the toenail over time could have several causes, one of which might be a subungual exostosis-a bony growth that can sometimes affect the nail. Although subungual exostosis can be identified on an X-ray, some cases might require further imaging, like an MRI, if bone changes aren't clearly visible. These types of growths, if causing pain or nail changes, may lead to discussions about potential removal or other management strategies. Since there are different types of nail bed growths that can appear similar, consulting with a specialist for a more precise evaluation could help clarify the nature of the growth and determine suitable treatment options.

Hi, Thanks for your comment. I recommend what is most comfortable when walking around in store. In saying that, I find my patients typically benefit from Asics, New Balance or Brooks store. Try on a recommended shoe from each store and see if they are comfortable for you. Depending on your pain, a wide toe box could be the trick. Remember that most shoes do not look like the shape of your foot so make sure you do have something wide enough for your foot profile. If you're still not finding luck or want to make sure you're right, see your local podiatrist.

Best of luck with your procedure!!

Unfortunately, yesterday I was supposed to have my surgery I developed gout so they had to cancel my surgery for about two weeks. I have to get rid of the gout first before he could touch my foot and on top of that we had 4 inches of snow.

@lisabaiocchi1228 no good at all. Acute gout around a joint can delay healing and make surgery difficult. In these cases, it is best to delay as frustrating as that can be.

I had my surgery February 7. I’m in recovery stage it’s been a week. Happy Valentine’s Day to everybody Friday. I go back to the foot doctor and we’ll see what happens. They also done a bunion removal on my little towel and plantar fasciitis ectomy all on the same foot. I’ve been hobbling all my heel for the past week. We’ll see what happens.

Just following up and seeing how you are healing.

Thank you for the kind words-I'm really glad the video was helpful! Subungual exostosis can be a challenging condition to deal with, so I hope the information made things a little clearer. Always happy to share info that supports you on your journey-take care!