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Sesamoid Removal prognosis

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Old 30th June 2008, 02:04 PM
David Schmidt David Schmidt is offline
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Default Sesamoid Removal prognosis

I recently had the fractured medial sesamoid under my big toe removed after years of trying other conervative treatments such as walking cam boot for 8 weeks to try to get the bone to fuse back together; a cortisone injection and orthotics made by the podiatrist. The surgery went well and it has only been 10 days post op and I go in today to have the stiches removed. Even in the boot I'm in, it is less painful and easier to get around than before; so I'm glas I went throught with the surgery.

My question is has anyone had this surgery before and is there any hope of returning back to semi-normal activity? I walk alot for exercise and would like to continue, once I'm healed from the surgery obviously but have also heard that a hallux valgus or bunion is more than likely to develop. At this point, I don't want to limit my activity based on the "more than likely" assumption, but is there anything I can do now to help keep this from happening?

thanks,

David
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Old 30th June 2008, 02:40 PM
FootDoc FootDoc is offline
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DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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Each of the hallux sesamoids are invested in their respective tendons of the flexor hallucis brevis muscle, which, ostensibly is a helper-flexor for the hallux, but in reality acts as more of a stabilizer of the hallux when in the push-off phase of gait. As with all sesamoids, they function to slightly divert the direction of pull of the tendon and in so doing give it a better mechanical advantage. During typical excision of the medial (tibial) sesamoid, some damage to the flexor hallucis brevis tendon in which it is invested is inevitable, and also, depending upon the skill of the surgeon, some weakening of the medial aspect of the first metatarsal joint capsule and the adjacent hallux abductus muscle may result. Due to both of these situations, there is indeed a tendency to allow for some degree of hallux valgus, especially in persons whose bio-mechanics tend toward that deformity anyhow. But all surgery in which some naturally-occurring structure is remove is a trade off between what was and what will hopefully be a better situation. You cannot remove necessary structures without some risk of consequence. It is not always easy or obvious for even an experienced surgeon to determine the long-term effect of his/her surgeries, as the majority of surgical patients are only transient within the practice, and may neither associate delayed untoward effects of the surgery with that surgery nor necessarily return to the same doctor if and when such situations occur. It may be that, in patients who tend to develop bunions mainly due to biomechanical problems related to excessive pronation, the use of orthotic devices may be preventative of problems, but I do not routinely advise my post-sesamoidectomy patients do anything in particular other than to lead normal lives. I certainly would, though, encourage you to discuss this with your own surgeon, rather than taking only the opinion of someone who does not know you, has not examined you nor knows exactly what was done.

Last edited by FootDoc; 30th June 2008 at 02:42 PM. Reason: correction
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