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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.
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Let me say first that I do not always take literally the interpretive diagnosis of a radiologist who essentially reads x-rays, scans, MRI and such, but frequently has limited hands-on experience with the clinical manifestations of what he is seeing. Few, if any, laboratory tests of any kind are able to stand on their own merits. By that I mean that lab tests are generally ADJUNCTS to diagnosis, and do not necessarily offer the definitive proof that many patients expect them do supply. They must be correlated with the findings of a skillful clinician.
In addition, one always has to be careful in relying, with absolute faith, when a radiologist uses the words, "compatible with." What that, very cryptically means, is that, although the situation looks as such, it is, by no means a "done deal," . . . and don't bet the farm on it.
Compensatory gait is always a consideration when a part of the foot is painful, and this can and frequently does put undue and perhaps unnatural stresses on other parts of the foot and perhaps the entire lower extremity as well as the spine. But, in my opinion, it is unlikely that problems caused in this manner would be permanent, extending for any substantial periods after the underlying foot problem is resolved.
Avascular necroses are poorly understood phenomena, and as such, treatment is generally uncertain and is often relegated to supportive measures. Many AVN conditions are self-limiting and go through a cycle of degeneration followed by eventual resolution. In areas, such as the head of the femur, which is an integral part of the hip joint, AVN can be devastating, as remodeling of the bone generally takes place, affecting the natural function of the joint. But, in the case of AVN of the sesamoid, any remodeling of such a small bone would likely have little if any effect.
Personally, it would be my judgment with the limited knowledge I have gleaned of the nitty-gritty of your case, and the fact that conservative treatment has been a failure, I would think that a total removal of the sesamoid would be the way to go. Empirics is commonly practice in medicine, and this may be a case for such. |
