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Wednesday, March 7, 2012

Sesamoid Fracture: Email Advice

This email was received today 3/7/12 regarding a sesamoid fracture. Sesamoids are 2 little bones under our first metatarsal head (ball of the foot).



Hi - I have seen a podiatrist and based on x-rays I have fractured my sesamoid. Currently, I'm in a knee high boot for 6 weeks but am a little confused about how this isn't putting pressure on the ball of my foot and keeping it from healing. I'm sure it takes some pressure off but would it be better to just keep it wrapped in an ACE bandage and using crutches as much as possible?
Dr Blake's comment: Great comment. You just have to produce a pain free environment for healing to occur, and weight bearing to important to strengthen bones. That being said if the removable boot is not painfree, it should be modified. I have had to place 1 inch of padding around the sore area to float the sesamoids to achieve that pain free environment, essentially creating a non weight bearing scenario. I have used crutches to accomplish the same, and since the weight of those boots are very heavy, if crutches then tennis shoes for a while may be appropriate. Whatever it takes. Painfree injuries tend to heal quicker to me, and pain is our guide to tissue strength thresholds. Go over the threshold with too much pressure, you risk slowly or preventing healing. This is a given. What is not a given is that even in this environment some injuries do not completely heal. I just want to give the bone the best chance possible, and that is not non-weight bearing in most cases. The bones weaken too much too quickly, and take forever (a little exaggeration) to restrengthen.

 Another question - what do you know about Exogen treatments to help fractures heal quicker?
Dr Blake's comment: I love Exogen bone stimulators by Smith and Nephew for sesamoid injuries. If the insurance allows, I would use them the day of the injury, or as soon as possible. Is your sesamoid injury a gross fracture (visibly in 2 pieces) or a stress fracture (faint line seen)? The gross fractures definitely should be bone stimmed. 

Anything else such as vitamin/mineral supplements?
Dr Blake's comments: Definitely a healthy diet with the recommended 1500 mg Calcium and 1000 units Vit D3. Of course, a supplement for added bone health is always good. 

 I'm am wholly against surgery so am wanting to be as aggressive as possible in doing everything right to get this to heal quickly.
Dr Blake's comment: You will be better to remove the word quickly, since it implies a time frame. Probably not want you meant, but I thought I would emphasize. Keep painfree, allow some pressure that does not hurt, see how the next few months go. I preach 3 months in the cast, with orthotics made during the third month and adjusted, so as I wean the patient from the boot, I have stable orthotics, they know how to spica tape, they have shoes that do not hurt, etc. During this time in the removable boot, try icing 10 minutes twice daily, and doing one 20 minute contrast bath each evening. By the time you are getting out of the cast, you are not inflammed, and all of the inserts and shoes you will be wearing for 2 to 6 months more have been worked out.

 I've read the horror stories about how people continue to have problems for months and years and it's scary. I want to make sure the podiatrist I'm seeing is giving me the best advice possible too and he doesn't seem to be concerned about the pressure I feel with the boot on. If there is any recommendation for a speicalist in Denver I'd appreciate it! Thank you so much for your blog!!
Dr Blake's comment: Sounds like the doc is treating you well, but if you want another opinion, call Dr Yakel in Brighton, Colorado for a referral to a good sports medicine podiatrist. Hope this helps you. 

By Anonymous on Sesamoid Fractures: Advice when not healing well at 10:58 AM

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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.