Dr. Timothy Young, a Board Certified Foot Surgeon Discusses Sesamoid Problems – Part 2

Problems with the sesamoid bones in the foot can be an overuse injury.  As mentioned previously, some sports have higher association of sesamoid problems,  such as dance.  The injury and damage to the bones can range from inflammation of the soft tissue around the sesamoid bone and capsule.  We call this sesamoiditis.  Further damage could lead to fracture of the bones and this is often readily seen on an x-ray.  The problem is that some individuals have sesamoids that, are as 2 separate bones or portions from birth (congenitally)  

Therefore, it can be difficult to determine if it is a fracture or if it is a structural congenital condition.  This is called a bipartite sesamoid when it is a congenital structural condition with 2 separate bones.  Additional problems may include damage to the blood supply of the bone or avascular necrosis.  This can be difficult to diagnose and often requires an MRI.  A typical office based examination would include x-ray evaluation of the sesamoid bones.  As mentioned this can clearly diagnose many fractures or arthritic conditions of the sesamoid bones.  More subtle changes can be seen with ultrasound imaging.  And as mentioned, an MRI is very useful for sesamoiditis especially if there is concern over potential avascular necrosis.

If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online today. 

Dr. Timothy Young - a Board Certified Foot Surgeon Discusses Sesamoid Problems –  Part 1

Sesamoid problems are fairly common in the feet.  There are 2 sesamoid bones at the base of the great toe joint.  These are small bones about the size of a pea.  A larger sesamoid bone is the patellar kneecap.  By definition, a sesamoid bone has a muscle and then the sesamoid bone which crosses the joint, and then there is a tendon from the sesamoid bone crossing over the joint to attach to  the other side of the joint.  In the knee, there is the quadricep muscle which attaches to the patella or kneecap, and then the knee Is attached to the tibia by the patellar tendon.  

This muscle sesamoid bone and tendon complex crosses the joint and gives leverage and protection to the mechanical function of the joint.  In the foot, the sesamoid bone can be very vulnerable.  As soon as the heel comes up off the ground during gait and other full weightbearing activities, the load and weight is transferred to the forefoot and up to have to wait or more will be transmitted through the sesamoid bones into the head of the first metatarsal.  Therefore, any running activity our other sports such as dance puts a heavy load on the sesamoid bones.  These are common activities with the sesamoid bones can be injured or damaged.

If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online. 

Dr. Timothy Young, a board-certified foot surgeon, discusses neuroma treatments:

Our Doctors have been using Alcohol injections for Morton's Neuroma for over 10 years with excellent success.  Most patients have between 6 - 8 injections at weekly intervals.  Occasionally a "mini-series" will be done after 12 months.  For most patients, there is minimal discomfort after the injections and there is progressive relief from the Neuroma symptoms. 

We typically use between 20-30% dehydrated alcohol.  Ultrasound guidance is critical for correct injection technique.  Most frequently we treat the 3^rd intermetatarsal space, and runner up is the 2^nd intermetatarsal space.  This provides an excellent alternative to surgical treatment, and we also treat stump neuroma problems (where there is reoccurrence of the neuroma symptoms after prior foot surgery).  

If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online. 

Dr. Timothy Young, a board-certified foot surgeon, discusses evaluation of bone healing status. 

How does your surgeon know when bone healing is adequate for unprotected weight-bearing for example if you have had bunion surgery and the bones were cut (osteotomy), then it’s important to stay in a protected boot or surgical shoe until there’s adequate bone healing. Typical bone healing takes approximately eight weeks for a healthy adult that can be less for young adult or teenager.  X-rays can be helpful.  A CT scan also can be helpful but can be quite expensive and often has artifact due to retained hardware causing magnetic interference with the imaging.  One additional tool that I like to utilize is ultrasound imaging. 

Ultrasound imaging can show subtle areas of bone bridging that you cannot see with a conventional radiograph.  X-ray findings often lag behind the actual bone healing status.  So, determining bone healing is always a challenge and based on a number of different indications such as age and health of the patient, appearance of x-rays, and post operative time frames.  Oftentimes I can get a better assessment of the actual bone healing by utilizing ultrasound imaging.  This often allows me to have our patients get out of their boot or cast earlier and then if I had to rely on x-rays alone.

If you are experiencing foot or ankle pain, give us a call today at 425-391-8666 or make an appointment online.