Thoughts on symptoms and MRI results?
I got diagnosed with a sesamoid stress fracture with nonunion and avascular necrosis two years ago and saw improvement with a boot, bone stimulator and hokas. Last month I suddenly had swelling around the base of my big toe (on top of my foot) and some swelling at the ball of my foot so i went back to my podiatrist. It hurts to bend my toe back and to crouch or go on tip tops (similar pain as previously experienced). Now mri results say this:
OSSEOUS STRUCTURES: Osseous alignment is normal. There is no evidence of a low
T1 signal intensity fracture line. Abnormal decreased T1, increased T2 signal is
seen within the medial sesamoid bone with evidence of an old incompletely healed
fracture noted within its central aspect. The appearance may reflect instability
at the level of prior fracture. Underlying avascular necrosis within one of the
sesamoid fracture fragments is difficult to entirely exclude. No additional
areas of abnormal marrow signal are appreciated.
JOINTS: Joint spaces are maintained. No joint effusion is seen.
LIGAMENTS: The visualized capsular ligaments appear intact and normal in signal.
The intersesamoid ligament appears well-maintained. The dorsal and volar
components of the Lisfranc ligament appear intact and normal in signal.
TENDONS: Unremarkable.
MUSCULATURE AND SOFT TISSUES: Unremarkable.
Report
Foot MRI
IMPRESSION:
No acute injury of the right forefoot.
There is evidence of old, nonhealed fracture identified involving the mid aspect
of the medial sesamoid bone with a mild degree of reactive edema present along
both sides of the previously identified fracture site. This raises suspicion for
reactive edema related to nonhealed fracture and associated instability.
Alternatively, developing osteonecrosis of one or both of the medial sesamoid
fracture fragments could have a similar appearance.
If conservative measures failed before, does this mean sesamoidectomy is the way to go? My doctor and nurse practitioner both mentioned surgery. I am an active healthy 20 yr old female for context