My name is Kathy and on a whim I’m hoping you might be able to offer me some hope.
I was diagnosed with a sesamoid fracture on 9/22/10. Acute onset of pain (for no particular reason) preceded by a few months of achy in ball of left foot. I believe it’s the tibial or sesamoid closer to other toes.
My first xray indicated a small crack in the bone smack in the middle of it, it reached the center...so wasn’t split totally in two pieces. I have been in a walking cam boot deal since. My xray follow up on 11/22 showed the same crack only slightly wider and maybe fractionally deeper. Pain DOES feel better but still unable to fully bend the toe (as in taking a normal step with full weight). My Dr. looked very confused by the xray comparisons.
I live in a semi remote area. Podiatrist not a sports med guy. My insurance will only cover folks in the vicinity, but really I can’t find ANY podiatrist anywhere who can seem to give me any kind of hope for this hideous thing.
I’m 38 have surfed avidly for 10 years, done yoga for 15+years, and snowboarded for almost 20. No heal wearing ever but lots of flip flop wearing.
Is this bone dead? Will it ever heal? I would love any help or advise you could offer. I am going crazy, lol.
Kathy, xrays can not be used to follow the progress of sesamoid fractures, except as a comparison 6 months down the line. Xrays actually look worse for 2 or 3 months because the healing process brings with it alot of fluid into the fracture site. This gives the fracture site a more washed out look for awhile during very healing, and is constantly being misinterpreted as poor healing. Palpation of the bone will also be sore for several years, so not a good indication of healing or lack of it. MRIs give very useful information and can be followed in 3 months. Before MRIs we just followed the patients symptoms, and that normally worked well. Truly function is the best indicator of overall healing.
Kathy, I would start the next phase of your co-existence with this injured bone by getting these several things accomplished:
- Put your foot on an ice pack 3 times daily for 10 minutes to reduce inflammation. You want to have all some symptoms from the break and none from the surrounding inflammation. Avoid anti-inflammatory meds since they can slow down bone healing.
- Talk to your podiatrist about getting a bone stimulator from Smith and Nephew called Exogen. You place on your foot 20 minutes twice daily. The bone stim company will work with you insurance company so you know what you have to pay beforehand. The bone stim will probably for the next 6 months.
- Discuss you Calcium and Vit D levels/intake with your internist to make sure they are not a problem. I would consider a bone density screen, and especially if you have any family history of osteoporosis. Get your Vit D 25 levels.
- Make sure you can make that removable boot into a painfree environment. All podiatrists know that one well.
- Learn how to do spica taping as shown on the video above.
- Get a baseline MRI. Plan on another one 3 or 4 months later.
- Have a PT show you some simple strengthening exercises to start doing now. Everyday you are losing strength, and it will take longer to get better the weaker your foot is, but you can not produce pain. My blog has ample exercises that you can review with the physical therapist including playing the piano, metatarsal doming, flat footed balancing, and inversion/eversion resistance band exercises.
- Read my blog post on good and bad pain and become good at this analysis.
This should be a good start for you. Good luck!! Rich