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RE: Dr W - Sesamoid removal

Posted by Mar on 4/19/03 at 17:14 (116587)

Dr Wander -

I saw my pod today and discussed your message about the removal of the sesamoid. He said he would only remove it as a very last choice and would recommend that if a do the RFL for the heels with Dr Cozz that we see if the sesamoid area can be done as well. Dr Cozz had said it was a possibility. My pod said that if (a big IF) he removes the sesamoid bone that has the pain, he would also remove the fibular sesamoid to balance it. Sound right? I just picked up a new pair of orthotics today - we'll see if they help the sesamoid or not. The lab has been working on them for 6 months!! Talk about learning patience!! Happy Holiday -- Mar

Re: RE: Dr W - Sesamoid removal

BGCPed on 4/19/03 at 18:58 (116595)

Do you mean 6 months total time in the lab or do you mean sending back and forth for adjustments?

Re: RE: Dr W - Sesamoid removal

Mar on 4/20/03 at 08:07 (116608)

My error - 5 1/2months!! I had a pair of hard orthotics that I wasn't able to wear that we sent back in October to make soft and make the front somewhat like a birk front with the well to relieve pressure on the sesamoid. They were gone 3 months. (Also sent a birk sandal for them to see and I was without that for the 3 months!!) Came back still hard and no birk front!!! Sent back again and just came in - 2 1/2 months. They are softer except on the ball of the foot where the sesamoid is!! And the ridge by the toes is in 2 different places on the 2 orthotics!! I guess we will send them back again. There is a Cped place in my home town but I don;t know anything about them. My pod said he could give me a script if i want to try them. I'm thinking about it. Any suggestions? Mar

Re: RE: Dr W - Sesamoid removal

BGCPed on 4/20/03 at 08:22 (116609)

I would try the cped, at least they can tweak them on the spot with your feedback. A myoelectric artificial arem doesnt take that long to make. Is your arch high or do you have a flat foot? What is the alignment of your met heads, in a perfect foot all five are on the same plane, like 5 bowling balls sitting on a rack they are all on the same level.

Many pt with sesamoid issues have a 1st met which is plantarflexed i.e. the big toe joint is lower than 2,3,4 and 5. Look at this upside down and it makes sense, 0oooo The device needs to balance the foot and spread wt all around EXCEPT under the 1st, there should be a round cut out about the size of a quarter (larger than a quarter if your feet are larger) and filled with about 4 mm of ppt or poron.

I would not be so concerned with those toe crests, they are not much use function wise and wont matter if the relief under the sesamoids and balance of the device is not correct. What area are you located, maybe somebody on here knows a person in your area. They time frame they are working in is nonsense

Re: RE: Dr W - Sesamoid removal

Mar on 4/20/03 at 08:39 (116610)

I live in Teaneck, NJ where I found on the internet a Cped group with a pod/cped. I just don;t know anything about them. Yes - 6 months is total nonsense. Fortunately I have a pair of orthotics that i wear everyday, but no matter what we have done to them manually, we can't relieve the sesamoid area. And I'm talking at least 3 doctors and myself trying. I wear Clarks' clogs around the house and they are the best - no pressure on sesamoid at all. The footbed is similar to birks but not as pronounced and they are soft and shock absorbent.

My arches are normal to high. The met heads -- the 1st and 4th are lower and more pronounced on both feet. I have a real problem with the 4th one on the left foot. My sesamoid problem is the right foot. Mar

Re: RE: Dr W - Sesamoid removal

Dr. David S. Wander on 4/20/03 at 10:08 (116615)

Mar,

I'm a little confused. You talk about 'your pod', and then mention Dr. Cozz (Dr. Cozzarelli) regarding the procedure planned for your heel. Are 'your pod' and Dr. Cozz the same, or are you talking about 2 different doctors? I'm not sure why 'your pod' is so reluctant to excise the sesamoid if it has been chronically painful and unresponsive to conservative care. Though it may certainly be a good idea to wait for Dr. Cozz to perform his procedure prior to considering any treatment for the sesamoid. If Dr. Cozz is not the doctor that is reluctant to perform the sesamoid surgery, I would suggest you speak with Dr. Cozz about the sesamoid, once the heel procedure is performed and hopefully relieves your heel pain.

As per one of my prior postings, there are ways to remove the symptomatic sesamoid and tighten the surrounding soft tissue to help minimize potential post op complications, without the need to remove the asymptomatic sesamoid. The soft tissue structures can be 'balanced' to avoid removing the other sesamoid, which can also lead to complications.

Once again, speak with Dr. Cozz, or give me a call.

Re: RE: Dr W - Sesamoid removal

Mar on 4/20/03 at 18:37 (116632)

Dr W -

OK - here's the pod story! There was the original pod who did the bunion surgery - Dr R. He was my pod from March 2001-Oct 2001. He never did any kind of post-op treatment even when i continued to have extreme pain. Told me to just keep being patient. So I went for a second opinion to Dr P in Nov 2001 and decided to switch to him. So he is the pod whom i consider my 'family' pod and the one I spoke of who is reluctant to remove the sesamoid. Then I went to Dr W in April 2002 for ESWT and he became my treating pod for the past year. Then I went to see Dr Cozz about the RFL just recently. Dr P is a very understanding and open doctor who didn;t know anything about ESWT but helped investigate it for me and get me set up. I suspect that you and Dr Z and Dr Cozz are much more current with treatment and surgery than Dr P, although I respect him and feel so comfortable with him and he always gives me more than enough time to discuss procedures. So that;s the pod story! So I have 4 pods plus you and Dr Z - that makes 6! And I'm still in pain!! ;-) I appreciate your insight on the surgery and will discuss it with Dr Cozz when I see him. Thanks - Mar

Re: RE: Dr W - Sesamoid removal

Dr. David S. Wander on 4/21/03 at 14:29 (116703)

Mar,

I actually know who Dr. 'R' and Dr. 'W' are. I don't know who Dr. 'P' is and this is beginning to sound like 'who's on first?'.

The bottom line is that you had a bad experience with Dr. R, like Dr. P but he may not be the most up to date on surgical or high tech techniques, you like Dr. W, but he is your ESWT guy and you are planning to have a procedure by Dr. Cozz. Apparently, the ESWT wasn't successful since you are going to see Dr. Cozz, or is it for a different heel problem??

If the sesamoid is still painful, it can be removed with complications minimized if performed correctly, without the need for removal of the asymptomatic sesamoid. Speak with me or ask Dr. Cozz about the sesamoid problem. One of these days you're actually going to come to Philadelphia and make an appointment in my office!

Re: RE: Dr W - Sesamoid removal

Mar on 4/21/03 at 17:10 (116723)

Dr Wander -

How do you know who Dr R is? I am very curious. 2 ESWT's with no relief at all. I am 'considering' a procedure with Dr Cozz. Complications can be 'minimized'???? Yikes! How about if I make an excursion of it and visit Dr Z and you? ;-) He asked first, so I don;t want to disappoint him! Although, he's away this week, so maybe I could sneak down to see you ;-) You wouldn;t tell would you?? ;-) By this summer I've got to make some decisions regarding the next step. I really would love to take a walk on the beach again before I die! Mar

Re: RE: Dr W - Sesamoid removal

Dr. David S. Wander on 4/21/03 at 19:55 (116747)

Mar,

I know who Dr. 'R' is, or should I say Dr. 'R.R.' (and his partner Dr. 'C')!!!!!! Now I've really got you curious don't I? Since Dr. Z and I live in Cherry Hill, within walking distance of one another, maybe you should just meet us in the middle! Or maybe you should make your appointments alphabetically. In the interim, ask Dr. Cozz what he thinks of isolated removal of the symptomatic sesamoid, since you've failed conservative care and have chronic discomfort. I'm sure he will agree, that if performed correctly, and the soft tissue is re-balanced, complications can be minimized and the asymptomatic sesamoid can be left intact. Now, all you've got to do is figure out how I know about Dr. R.

Re: RE: Dr W - Sesamoid removal

Mar on 4/22/03 at 07:51 (116782)

Dr W -

Ok - you're killing me now! Maybe you found out who R.R. is (yes his partner is C) from Dr W? I love a good mystery, but I think I just busted you! Do you know RR personally? I liked RR but he didn't DO anything to help me and he was burned out too, which is probably why he didn;t do anything. So you want me to visit alphabetically? Maybe you guys could bid on me -- then I could make up some of the money for the ESWT!! Was that a low blow? ;-) Don't have any appointments with Dr Cozz scheduled until I decide when to have the RFL. Actually I will probably visit Dr Z or you or both before doing that. How far in time/distance is your office from his? I will probably have to take a day off work to do it - maybe I can visit you both on the same day! Mar

Re: RE: Dr W - Sesamoid removal

Dr. David S. Wander on 4/22/03 at 08:32 (116789)

Mar, sorry but I never spoke with Dr. W. Yes, I do know Dr. RR very well but we have NEVER discussed you. Actually, you once mentioned his name in an email to me. Dr. Z's office is in Woodbury NJ and my office is in Philadelphia, so the offices are about 30 minutes apart. It would be silly for you to come to both offices in one day, so simply do what you think is right. I doubt if either decision would be wrong.