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This is an e-mail question I received from a dog owner. I though it would be interesting to put here and see if it facilitated any discussion AND to see if others have thoughts on this!

Hi Laurie,

I just read your blog from 2016 about sesamoid fractures. I'm not sure if my pups case is different since he was diagnosed with sesamoid bone disease which is genetic and not necessarily fractures caused by trauma but more a degenerative disease? At least that's how I understood it. It took forever to find out why my pup was limping. He's always limped on just his right foot for the last 4 years even though he has the disease in both feet. I've done so many different things for him. Most recently I've been doing prp injections into his toes. Now he's limping on his left! Really bad and not responding to prp injections or rimadyl or gabapentin! I'm afraid surgery is my last option. Then I read your blog. This poor dog has been thru so much. He was first misdiagnosed as having medial shoulder instability (at least I believe he was misdiagnosed since he was still limping when he wore his hobble brace). As I said earlier, I'm not sure if my my pups case is different since it seems to be the genetic type but do you have any suggestions or do you think padding is still worth a try? Any info will be great. Thanks!! The vets here say the surgery is very difficult since the bones are so small and there are so many nerves involved, etc.

Thanks,
HW

Hi H,

I’m sorry about your pup. It sounds very frustrating!

So, I’d approach it this way. Try some cushioning - either home made, or try the Cushy Paws booties made by Therapaw (http://www.therapaw.com). If cushioning helps, then the sesamoids are likely the problem.
If the cushioning does nothing, then you may need to look for a different reason for the limping.
Hobbles alone don’t usually make a dog sound. Often it takes therapeutic exercise, some joint mobilizations, and modalities to help the joint to heal and to support it.
Also try sticking your finger in under the main carpal pad - trying to touch the ‘bottom’ of the joint located there to see if there’s pain. You don’t really need to know what your doing. If there is pain in the region, then the sesamoid bones could be the cause.
This way you have two ways of testing to see if the sesamoids are the root of the limping and/or causing pain.

Now, I’ve only seen one that was post-operative (removal of the sesamoid bone)… and that dog was still lame. So surgery might not be the answer anyways. Which takes us back to padded boots.
If padding works (start with indoors use), the progress to getting more heavy duty boots for outdoors that you can add extra padding to.

Does your vet clinic (or one near by) have access to a laser. That might be worth a try and is likely cheaper than PRP. Other options would be a PEMF loop (HealFast Loop or Assisi Loop) that you could use at home to treat your dog. Have you tried any kind of arthritis supplement? If it’s degenerative, a supplement MIGHT help. I’d look for something that works on inflammation as well as joint cartilage (Glucosamine is good for slowing joint cartilage degeneration, MSM is good for inflammation, Omega Fatty Acids help with inflammation and joint degeneration, Turmeric - aka ‘golden paste’ might help with inflammation as well, CBD oil can help with both inflammation and pain.) There’s lots you could try. Your vets are right, it a small finicky little space to get in and do surgery on. I’d keep that as a last resort.

I hope this helps and gives you a bit of direction towards things you can try!

Best of luck!

Laurie

I can't find the paper, but there was a VCOT study that showed long term outcomes of sessamoid surgery were worse than conservative therapy outcomes. My 1st line modality for sessamoid issues is ESWT. I've gotten good results with PRP'ing phalangeal OA, but not for sessamoid disease.

Thanks David!

So, I went hunting for it, and found the following article which references the VCOT article you talk about! Thanks for point us in this direction!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748296/

Cheers,

Laurie

I've only seen one case with a fractured sesamoid, but dog did well with laser, Assisi Loop and foot padding.
Diane

Hi all, I have a couple of cases of sesamoid disease I am managing at the moment, not very easy cases! I have just looked up the assisi loop, I haven't heard of it before. I think I understand it correctly that's it's a form of PEME? Do you find them a useful tool and do you sell them or rent them out to clients?
Thanks for your help
Nicky

Hi Nicky,
Yes, it's a form of PEMF. Their website is pretty helpful if you haven't run across it yet.
Overall, I have found them useful. I did have one elbow osteoarthritis case where the owner didn't think it was helpful--but the OA was horrible in this dog and nothing seemed to help.
The disadvantage is they have a limited lifespan and are a bit of an investment for the client, so I usually tell clients to check out their website before they decide to make the purchase. I usually sell them to the client.
Diane