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Thursday, February 2, 2023

Sesamoid MRIs: What is Going On? Is There Still Healing Occurring?

T2 images showing inflamed fibular sesamoid

T2 images showing normal tibial sesamoid
Greeting from San Francisco

T1 image showing intact stable but injured fibular sesamoid. The grey part of the bone indicates bone activity. 

Another T1 image of injured fibular sesamoid. Healing fine. No AVN or avascular necrosis

Great T1 image of both sesamoids. The injured fibular sesamoid has the re-moldeling area in the middle which looks more grey. No AVN or fragmentation.

     I have shown both T1 (normal bone white) and T2 (normal bone black) images. When a patient develops AVN, both T1 and T2 are black. Definitely not in this case. 


  1. What was your advice to this patient? Surgery?

    1. Surgical decision would have to follow failure to progress in treatment. Since, at the time of the images, there was no sign of AVN or fragmentation, conservative treatment seems the best route for now. I would evaluate every 3 months, and typically new MRI every 6 months, if I have gotten the pain consistently to 0-2 VAS, to check progress. Rich


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.