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sesamoidectomy

Discussion in 'Ask your questions here' started by Unregistered, Apr 20, 2010.

  1. Unregistered

    Unregistered Guest


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    I have had sesamoid pain for at least 4 years and have tried many treatments, ie orthotics and cortisone injections. My doc has now recommended the removal of the fibular sesamoid after seeing mri results. My question is can the foot function normally without that sesamoid?
     
  2. FootDoc

    FootDoc New Member

    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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    Although "function normally" would technically imply that one could function precisely the same with or without a body part, for all intents and purposes, the vast majority of those persons having had a sesamoidectomy would not be aware that it was missing and their foot function would generally be seen as grossly normal. But that is not to say that there can be no adverse consequences to a sesamoidectomy.

    I am curious though, as the sesamoid which is the problem in sesamoiditis is almost always the tibial and not the fibular sesamoid. Why was an MRI necessary and what was seen on the MRI which convinced your doctor to remove the fibular sesamoid.
     
  3. Unregistered

    Unregistered Guest

    Thanks for the response. The mri was done because of pain and swelling and no relief over the years. He told me the fibular sesamoid was bone on bone, extremely inflammed and it had a separate fragment/spur on it.

    I should have clarifed my "function normally" statement. I am very concerned about removing this bone and am trying to find out what complications could arise. It is very important to me to be able to continue walking for daily exercise.
     
  4. FootDoc

    FootDoc New Member

    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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    I wouldn't say that was not possible, but, as for me personally, I'd have to see it to believe it. Did you have any history of overt trauma to the sesamoid?

    First, let's make sure we both are on the same page. The fibular sesamoid is on the lateral side of the first metatarsal head . . the side closer to the 2nd metatarsal. A sesamoid bone is one that develops within a tendon and its function is to give greater mechanical advantage to that tendon. The sesamoids beneath the first metatarsal head are invested in the tibial and fibular tendons of the flexor hallucis brevis respectively. The functions of that muscle is to help flex the great toe and to stabilize the great toe during pushoff phase of gait. The more important function is the later one. It is often difficult to remove either of the sesamoids and especially the fibular one without damage to the tendon in which it is invested. Loss of both of these tendons could result in a cock-up toe deformity and poor stabilization at pushoff. This is less likely when only one tendon is damaged. Also, there is some risk of hallux valgus when the tibial tendon is damaged and hallux varus when the fibular one is damaged. It has been my experience that it is rare that the fibular sesamoid is the cause of sesamoiditis, and I have never removed one for that purpose, although I have removed many in performing modified McBride bunionectomies. It might be difficult to remove a fibular sesamoid which is not displaced into the metatarsal interspace as is the case when it is removed during a bunion procedure.

    The bottom line answer to your questions is that the removal of either sesamoid has the potential to affect foot function, but I have seen that occur only infrequently. All this said, it matters not what my experience has been. You need to check with the doctor who is doing YOUR procedure. Find out how many he/she has done and what the success/failure/complication rate was in HIS/HER hands. All else is speculative and academic.
     
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