Sesamoiditis/Sesamoid Fractures

[suzanne]

I have a shattered sesamoid and the bone is dying. I have lived with it with relatively little discomfort. Now this week it seems very painful and different-especially in the tendons. I cannot have anyone tell me WHY I should have it removed. This is big surgery since so many tendons are attached. What does having it removed accomplish?

Suz

[footankledoc]

Before considering excision of the sesamoid, I would try a custom orthotic which may off-weight the area so it doesn't get irritated or even trying a walking boot and use of a bone stimulator. If in the chance that has already been tried, then excision is the last option to remove the discomfort. It's not a big of a surgery as compared to all the all the other surgery podiatrists perform. Yes, there are quite a bit of attachments to the sesamoid, but once it is removed, the surgeon will appropriately brace and splint the area and you'll have full function once all the healing is done. Be sure to fully discuss all the ins and outs with your surgeon if you do decide to proceed with the excision. Hope this helps!

[suzanne]

But what would happen if I did not have it removed? I was told bones that die dissolve. I did the boot for 6 months. It is shattered-orthotics did nothing....I wore it the other day for one day and was 90% better again after that one day. I could feel major shifting three times that day and was shocked how good it felt 12 hours later. It is because I wore flip flops for a week on vacation I think that it hurt so much.

I think maybe the surgery is more of a risk and more painful than nothing at all-especially because I am in retail on hard floors and I am a competitive athlete. What happens other than continued pain and discomfort if I do not have it removed? And after it is removed do I recover to like it never happened before? How will it feel and how will my foot perform? I can read all about the surgery but no one is selling me on the risks vs benefits etc.

Thanks for your input!!

[footankledoc]

If you decide to not have it removed, then yes, it would be just chronic pain and discomfort. The fact that orthotics did help 90% is a good sign that orthotics do help. Depending on which sesamoid it is, you don't lose any function in the big toe joint. Nothing is ever guaranteed in surgery but a majority of patients do very well and return to full function after excision. The only risks to the surgery (and it's for all surgery) is prolonged pain, swelling, infection, and reaction to the anesthesia. Specific potential risks (which are rare) is dependant on which sesamoid is removed. If it's the tibial sesamoid which if you look on the x-ray in the one closer to the inside of the foot, then a potential risk is forming a bunion. If it's the fibular sesamoid, the one next to it, you could have the big toe drifting away from the 2nd toe. These types of potential risks are very rare and post-operative splinting takes care of it. The only other risk is just return of pain. You do what's in your best interest and that's between you and your physician. Hope I shed some more light on the subject.