Sesamoiditis: Email Advice

Email Received: 2/13/11 from Maryland

Hi Dr. Blake-

I just came across your information on the internet. I just had my big toe evaluated here locally in Maryland, and after I insisted to the podiatrist that it was swollen, an X-RAY was taken and the X-RAY showed that the outer sesamoid has fractured in two places – one a straight-through (not non-union yet according to the podiatrist) and the other hairline fracture. The podiatrist recommended that I wear a “boot” for about 6-8 weeks, but he didn’t have a size that would fit my foot (size 13.5 or 14), so I am waiting. The pain isn’t unbearable but I can feel pain when I walk or apply pressure. My characteristics: 40 years old, 6’2”, 255lb

Questions:

1. I do not remember a specific event that caused this fracture – I have been working out but not running – more ellptical, walking on treadmill, and doing weight-lifting upper body and lower body – so is it uncommon that a situation like this seems to spontaneously occur? My buddy’s father who is a doctor said that I should have a follow-up to check for “bone density, vitamin D, mineral density checks” with a rheumatolagist. Is that reasonable?

2. I just ordered a metasaral pad to wear underneath of my foot – recommended?

3. My podiatrist said that I could do elliptical exercises while I wait for the foot to heal, but when I tried yesterday my toe area seemed to hurt more – I tried elliptical and sit-down bike. Recommended?

4. Is swimming non-impact enough?

Any thoughts would be greatly appreciated ---

Troy

Dear Troy,
     First of all it is very difficult to make the diagnosis off xrays since many unpainful sesamoids are in two, three, or multiple pieces. These are called bipartite/tripartite sesamoids. The bone just never fully ossified in the teenage years. Of course, you have to treat the worse case scenario initially until you get an MRI or bone scan to document the fracture's existence without doubt. The removable boot sounds the right idea, and you can have it Fed Exed in two days from Alimed.com or mooremedical.com. I would get the low cut version, like the Anklizer.
     It is common to get sesamoid problems from elliptical machines since they are a solid metal unforgiving platform. It is common to get sesamoid problems from treadmill, especially if you are not used to it, have it on an incline, or trying to recently increase your speed. This being said definitely stay off these two machines until you can walk for 2 weeks without pain. The stationary bike is the drug of choice for sesamoid injuries since you can put pedal back into your arch and off the injured bone.
     The advice on getting Vitamin D levels and bone density screens is appropriate. Make sure you are at 1500mg Calcium and 1000 units Vitamin D until told otherwise.
     My blog has various posts on sesamoid injuries and you can see how easy it is to design your own dancer's pad and learn spica taping (both crucial). Swim only if you can swim, but avoid pushing off the walls. I sink!!
     Let me know after your MRI or bone scan what they found (ok to email a photo like the one below). Good luck. Rich

I received this 2nd email after I had typed the above response.

Thank you and I just came across your good instructions on the


http://www.drblakeshealingsole.com/2010/12/sesamoid-fracture-email-advice.html


I am afraid that if I sit here inactive for months at a time I won’t lose any weight—I was thinking of water acquatics for low –impact –hopefully I can do this – I just ordered the Kinesiotape   

Troy, spend 30 minutes on the bike tomorrow and gradually add another 5 minutes every 5th day. Lower the seat alittle to compensate for the change in pedal position. You should be able to burn a few calories. Rich