Sesamoiditis/Sesamoid Fractures

[Guest]

Dear Dr,
Thank you for your answer. After a cat scan, MRI bone scan, we are still not sure of a diagnostic (sesamoiditis, fracture, bipartite...!)Surgery was considered and i asked for what your suggested. So i am getting a cortisone shot in the area next thursday. I will add also resting for 4 weeks. I would like your opinion on what is the best way to avoid weight bearing on it and provide immobilization. I thought about using crutches but i wonder if there would be a special shoe i could use. THe pain is getting worst by the day and each step now is getting painful. I would appreciate your advise. Also, if i do have to go through surgery later on, the orthopedist i am seeing now has done only 4 operations of this type,is this a problem ? Is it a simple operation or do I need to look for somebody who really do this type of surgery often? Thanks again for all your help.catherine

[Guest]

Crutches would really be your best option because a shoe would still put weight on the sesamoids. If the doctor you are seeing has only done four surgeries in the past, you may want to get a second opinion. Also, please write back and let me know if the bone scan showed focal uptake in the area of the sesamoids. You went through the troubleof haviing all of these tests and even negative results are very diagnostic. Therefore, any results you can tell me about may be helpful. Good luck and please write back.
[quote] Dear Dr,
Thank you for your answer. After a cat scan, MRI, bone scan, we are still not sure of a diagnostic (sesamoiditis, fracture, bipartite... [/quote]

[Guest]

Dear Dr,
Thank you for your interest. The MRI reads the following: Evidence of increased signal intensity throughout the fibular S. consistent with significant bone edema. There appear to be multiple fragments of the fibula and the possibility of fracture cannot be excluded. This could possibly represent a bipartite patella with significant bone edema, contusion or sesamoiditis. Clinial correlation is recommended. The tibial S. is unremarkable.
The bone scan reads: A triple phase bone scan was performed. The examination demonstrates increased flow, soft tissue uptake and intense bony uptake at the lateral sesamoid bone of the great left toe.The scintigraphic findings are consistent with a fracture of the lateral sesamoid bone of the left great toe. Differential diagnosis includes infection or infarction.
THAT'S IT!
I hope this is helpful because it is not for me. What is the "focal uptake" you were looking for? And is it in my report? I find both reports to be covering their Butt! for all possibilities!! What do you think?
It's great reading your answer. I am going to get crutches tomorrow to use after the cortisone shot and i guess i will not be wearing any shoe at all as you say it will be putting pressure on the sesamoid. Talk to you soon. cathy
update on aug 1st: I had the shot this morning at the hospital so the Dr could use the xray machine and see where to inject. It was done under local anesthesia. A little bit painful but i survived. I am waiting for your answer after the description of my MRI and bone scan report. Maybe you are on vacations at the moment. Oh well i have to be patient! Talk to you soon i hope. cathy
[quote] Crutches would really be your best option because a shoe would still put weight on the sesamoids. If the doctor you are seeing has only done four surgeries in the past, you may want to get a second opinion... [/quote]

[Guest]

The bone scan does shows increase flow which is the focal uptake I was talking about. This typically means that the sesamoid was fractured rather than bipartite which would mean you were born with it. The bad news is that sesamoids normally do not heal back together by growing bone across the gap. The good news is that fibrous tissue normally fills the gap and the pain eventually goes away. Hopefully, the cortisone shot helped reduce teh discomfort. The other good news is that the if it remains painful, having surgery to remove the fibular sesamoid has a much better prognosis than removing teh tibial sesamoid. You honestly should wear sneakers to help cushion the area rather than walking barefoot. Sorry the reply took so long; computer glitches hid your reply for a few days. Please write back with any other questions.
[quote] Dear Dr,
Thank you for your interest. The MRI reads the following: Evidence of increased signal intensity throughout the fibular S... [/quote]

[Guest]

Thank you Dr for your answer. I sincerely hope the shot will help avoid surgery. So far the area is still a little bit swollen from the shot et it definitely still hurt! I am using crutches and not putting any weight on the foot. I wonder how long will it take to see decrease of the pain or if i will see any! I was hoping it was a sesamoiditis but i guess you cleared that out of the way. Do all people who had a fracture sesamoid need to have it removed? Or can you live with a fracture sesamoid?
Also if looking for a surgeon is my last option, how many of the same surgery do you think that surgeon should have done? THanks again for all your help.
[quote] The bone scan does shows increase flow which is the focal uptake I was talking about. This typically means that the sesamoid was fractured rather than bipartite which would mean you were born with it... [/quote]

[Guest]

Dear Dr
It has been 11 days since the cortisone injection and no sign of relief. I have stopped my job as a massage therapist and i am resting my foot at home but no improvement. Is it too early to consider surgery? Also, what is the best method of anesthesia? Full or local? Thank you. cathy
[quote] Thank you Dr for your answer. I sincerely hope the shot will help avoid surgery... [/quote]

[Guest]

I would consider surgery at this time if it is causing you so much pain that you cannot work. You can be sedated and then local anesthesia can be injected to make the area numb. The sedation will allow you to breathe but not remember the procedure.
[quote] Dear Dr
It has been 11 days since the cortisone injection and no sign of relief. I have stopped my job as a massage therapist and i am resting my foot at home but no improvement... [/quote]