| Subject: RE: Sesmoid, great right toe |
Author: Bernie Secoura
Date: 11/6/2004 6:53 am PDT
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DISCLAIMER:
THE FOLLOWING IS OFFERED AS GENERAL INFORMATION ONLY, AND MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER'S PROBLEM. IT IS NOT BASED ON ACTUAL KNOWLEDGE OR EXAMINATION OF THE QUESTIONER AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION. ONLY THROUGH HANDS ON PHYSICAL CONTACT WITH PATIENTS CAN ACCURATE MEDICAL ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER SHOULD CONTACT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS FORTHCOMING HEREIN.
Your case, more than some presented here, would clearly require a through hands-on examination in order to arrive at a likely solution. But I will make some assumptions as to what I THINK you're relating, and base my assessment on those assumptions being correct.
I will take you at your word that you are speaking of a hallux (great toe)sesamoid and NOT the normally occurring sesamoids which occurs in pairs beneath the first metatarsal head.
If that is correct, you had what is know as an ACCESSORY sesamoid on the plantar surface of the great toe within the long flexor tendon and beneath the joint of the two bones which make up the great toe. Although this is not a normally occurring bone, it occurs frequently enough so that it has a name . . "hallux sesamoid."
Assuming that all that I have said above is correct, I'll go on . . That being said, I am a bit mystified as to why symptoms of "(your) foot swelling up over night," led to this diagnosis and resulted in the treatment you were given. The signs and symptoms of this condition are generally a painful callus beneath the accessory sesamoid. What I usually do as a diagnostic test is to circle the callous with a thin wire and take x-rays, both from the top and the side to see if the sesamoid's positional relation to the callous.
From what I hear you relate, your doctor removed the sesamoid and shave down the prominences of the plantar condyles of the head of the proximal phalanx of the great toe and perhaps the base of the distal phalanx. (A word of explanation . . The great toe (or hallux) consists of two bones (phalanges). . the first one or proximal phalanx is closest to the body of the foot and the second one or distal phalanx, is the end bone). I do no know why your doctor found it necessary to use metal sutures and I kinda doubt that, unless he used cat gut for internal suturing (rarely employed any more) that you really had an allergic reaction to the internal sutures. Chances are that the incision was made on the plantar surface and you weren't placed on crutches to avoid weight bearing after surgery, and THAT resulted in excessive fibrosis of the scar.
Now, let me suggest what might be going wrong. The great toe normally flexes upward (dorsi-flexion) through a good range of motion at the joint between the first metatarsal and the base of the proximal phalanx of the great toes. This motion is essential in normal walking. There is normally some plantar flexion (down movement) available at the interphalangeal joint of the great toe (the joint between the proximal and distal phalanges), but only slight, if any, dorsi-flexion (upward movement) at this joint. Most often the extent of dorsi-flexion is to simply straighten the joint to a neutral position. In some, however, there is the ability to actually bring this joint into real dorsi-flexion. This is known as HYPER-EXTENSION) This may be just the way your joint was created, or it may be compensatory for lack of full range of dorsiflexion at the first metatarsal-great toe joint. In either event, what occurs with the hyperextension is that the condyles of the head of the proximal phalanx and/or the base of the distal phalanx of the great toes are brought into prominence as the hyperextension takes place and inordinate and unnatural weight bearing occurs at this point. This often results in the formation of a callous, but can easily cause the formation of an adventitious bursa intended for protection, but then subject to becoming inflamed (bursitis). If my scenario is correct, this is what your doctor is terming a cyst.
Further assuming that all I have said is correct . . What to do? First of all, I would try a custom made latex pad which would slip over the toe and pad the area of concern. If this was insufficient and there were clearly hyperextension at the joint . . and if the condition was sufficiently bothersome to you, I might suggest either an arthroplasty of the interphalangeal joint of the great toe or a fusion of that joint.
All this is predicated on too many assumptions to be relied on as a definitive opinion in the case. I would simply suggest that you run my thoughts past your doctor and see what he thinks.
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Sally |
11/5/2004 8:31 pm PDT |
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RE: Sesmoid, great right toe |
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Bernie Secoura |
11/6/2004 6:53 am PDT |
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