Subject: RE: sesimoiditis |
Author: Foot Doc
Date: 9/26/2007 5:13 pm PDT
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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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I can think of no valid reason why anyone under the care of a competent podiatrist should be suffering the pain of sesamoidits for as long of a period as you state. First, it should be said that sesamoiditis is generally a "clinical," diagnosis based only on symptoms of pain on weight-bearing in and about the area of the sesamoids, rather than any technique which might definitively verify that diagnosis. So, one possibility is that perhaps you have not been diagnosed correctly. Other problems which might invoke similar symptoms are a non or mal-united fracture of the sesamoid, an avascular necrosis of the sesamoid and a chronic low-grade osteomyelitis and sub-metatarsal head bursitis. But assuming that you have been correctly diagnosed, and that there is no osseous pathology seen on x-rays, conservative treatment with anti-inflamatories (corticosteroids and/or NSAID's) padding and rest generally affects a resolusion of the symptoms. It is essential, though, that the likely bio-mechanical problems underlying the condition be effectively addressed if the relief is to be permanent. When appropriate conservative care has been sufficiently attempted without marked mitigation or resolution of the problem, surgery to remove the tibial sesamoid (generally the one involved) is considered. As with all surgeries (and all medical treatments in general), there are risks, potential side effect and failures. But I certainly advise such surgery in my patients as a final resort to relieve the pain, and I have found it generally quite effective. Yes, the sesamoids do have a function in providing a fulcrum for the tendons of the short flexor of the great toe, but when body parts are removed anywhere, it is always with the anticipation that their minor loss of function is ofset by relief of whatever problem they are creating. The biggest drawback to the procedure when performed on the tibial sesamoid is damage to and weakening of the tendon of the medial head of the short flexor of the great toe, which, in patients who tend toward hallux valugus (great toe drifting toward 5th toe as in a typical bunion), can sometimes precipitate further drifting of the toe. In my experience, addressing this during the surgery and employing appropriate tissue handling techniques can mitigate or totally eliminate this side effect. The surgery itself takes a very short amount of time and rarely results in a great deal of post-operative pain or lenghty recovery period.
But whether or not you now require surgery can only be assessed by an in-depth review of your case and a hands-on examination. |
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peter |
9/26/2007 12:12 am PDT |
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Betsy Hunt |
9/26/2007 4:05 pm PDT |
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Foot Doc |
9/26/2007 5:13 pm PDT |
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Laura |
10/2/2007 7:21 am PDT |
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Foot Doc |
10/4/2007 11:33 am PDT |
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Laura |
10/10/2007 9:19 am PDT |
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Foot Doc |
10/10/2007 11:08 am PDT |
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Laura |
10/11/2007 6:13 am PDT |
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ceenasumqeas |
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