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Thoughts on sesamoidectomy?

Posted by C Chotiner on 9/15/00 at 13:57 (028300)

I have had pain in the ball of my right foot for years, and even had x-rays and a bone scan. It is a stress fracture in the (medial, I think) sesamoid bone - but the bone itself looks very fragmented. I have worn orthotics for a year, but still have pain. I think the next step is removal of the bone. I have tried to find more information on the surgery, but have had trouble. What are some of the pros and cons to the surgery? How often is it done? etc.??

Re: Thoughts on sesamoidectomy?

Dr. Zuckerman on 9/15/00 at 15:10 (028301)

I have done this surgery many times in the last twenty years. Very easy to perform. I would x-ray the other foot to compare the fragmentation of the medial or tibial sesamoid witht he painful one . This will give an excellent insigt into whether there is any fracture and or deformity with the painful tibial sesamoid bone

Re: Thoughts on sesamoidectomy?

C Chotiner on 9/15/00 at 16:23 (028310)

What is the typical recovery time? Success rate? What about returning to normal activities (ie tennis)? Thanks.

Re: Thoughts on sesamoidectomy?

DR. Zuckerman on 9/15/00 at 18:21 (028316)

about eight weeks.Depends on the right reason for the procedure.
If you have a plantarflexed first metatarsal and or ray failure is in 100% of the cases. Tennis eight weeks. Can you play tennis now

Re: Thoughts on sesamoidectomy?

Dr. Biehler on 9/15/00 at 18:24 (028317)

A thought along these lines. I have found that in the design of some shoes, they let part of the foot and toes overhang the sole. In patients with sessamoiditiis I have found by running my hand inside their shoe that the top edge of their hard sole is pushing up right on or inbetween their sessamoid. This has to be checked before surgery.

Re: Thoughts on sesamoidectomy?

Dr. Zuckerman on 9/15/00 at 18:36 (028321)

Good point Dr. B. I still think that the correct diagnosis need to be made. IS this a fracture or a bi or tri parate sesamoid. Bilateral x-ray need to be taken. Correct forefoot and rearfoot control and accomadation is very important with the fabrication of biomechancial orthosis.

Re: Thoughts on sesamoidectomy?

C Chotiner on 9/18/00 at 10:21 (028516)

I have still been able to play tennis, as well as walk. Some days it hurts worse than others. There is definitely a fracture. You can see the difference when compared to a '97 x-ray. What is a plantarflexed metatarsal? I'm not sure I understood that reply.

Re: Thoughts on sesamoidectomy?

Dr. Zuckerman on 9/18/00 at 19:33 (028585)

That is where the angle of the first metatarsal bone is steep in it angle to the floor. The sesamoid bones are right under this bone. If the steepness of the bone is abnormal this will contribute to the sesamoid pain and or fracture pain.

Re: Thoughts on sesamoidectomy?

Dr. Zuckerman on 9/15/00 at 15:10 (028301)

I have done this surgery many times in the last twenty years. Very easy to perform. I would x-ray the other foot to compare the fragmentation of the medial or tibial sesamoid witht he painful one . This will give an excellent insigt into whether there is any fracture and or deformity with the painful tibial sesamoid bone

Re: Thoughts on sesamoidectomy?

C Chotiner on 9/15/00 at 16:23 (028310)

What is the typical recovery time? Success rate? What about returning to normal activities (ie tennis)? Thanks.

Re: Thoughts on sesamoidectomy?

DR. Zuckerman on 9/15/00 at 18:21 (028316)

about eight weeks.Depends on the right reason for the procedure.
If you have a plantarflexed first metatarsal and or ray failure is in 100% of the cases. Tennis eight weeks. Can you play tennis now

Re: Thoughts on sesamoidectomy?

Dr. Biehler on 9/15/00 at 18:24 (028317)

A thought along these lines. I have found that in the design of some shoes, they let part of the foot and toes overhang the sole. In patients with sessamoiditiis I have found by running my hand inside their shoe that the top edge of their hard sole is pushing up right on or inbetween their sessamoid. This has to be checked before surgery.

Re: Thoughts on sesamoidectomy?

Dr. Zuckerman on 9/15/00 at 18:36 (028321)

Good point Dr. B. I still think that the correct diagnosis need to be made. IS this a fracture or a bi or tri parate sesamoid. Bilateral x-ray need to be taken. Correct forefoot and rearfoot control and accomadation is very important with the fabrication of biomechancial orthosis.

Re: Thoughts on sesamoidectomy?

C Chotiner on 9/18/00 at 10:21 (028516)

I have still been able to play tennis, as well as walk. Some days it hurts worse than others. There is definitely a fracture. You can see the difference when compared to a '97 x-ray. What is a plantarflexed metatarsal? I'm not sure I understood that reply.

Re: Thoughts on sesamoidectomy?

Dr. Zuckerman on 9/18/00 at 19:33 (028585)

That is where the angle of the first metatarsal bone is steep in it angle to the floor. The sesamoid bones are right under this bone. If the steepness of the bone is abnormal this will contribute to the sesamoid pain and or fracture pain.