Dr Blake's comment: Sesamoids can become painful. When xrayed, sesamoids can be in more than one piece. It seems that no one agrees on how to treat these, relying on one generalization or another. The patient's pain should be treated, a pain free environment created quickly, and serious fractures will heal slower than bruised bi- or tri-partite naturally occurring bones.
|Tibial Sesamoid in 2 pieces. Broken???|
Looking back now a year later, it prob really didn't matter what it started out as, over the past year it hasn't been stable. On the axial view the width of my injured sesamoid has spread from about 8mm to just over 9mm. I have included a comparison view of the films I have taken over the past year.
Dr Blake's comment: Due to privacy, I did not include the images since it identified the patient.
Dr Blake's comment: Cortisone in a joint that has the potential to heal should be done very carefully. Feeling better now may, in the long run, not be the best.
(As a chiropractor this was very difficult for me... our profession is based on the fact that the body is self-healing and self-regulating, so to do something to just cover the pain was hard.) It had increased sensitivity and tenderness for about 2 weeks after the injection, then it was back to pretty much the same as before the injection. And that's where I am now...
First of all, get an MRI and send me all the images (X-rays plus MRI), at the same time you review with your podiatrist. The MRI will need to be done twice, now and in 6 months to check healing, but the immediate one will tell us a lot on what is going on now. We can hopefully discuss the images on this blog.
Secondly, make sure your Calcium and Vit D3 intake is normal. If there is any chance you have osteopenia, get a bone density screen.
Thirdly, continue to try to create a pain free environment with experimentation of shoes, inserts, removable boots for non work hours, work standing positions, daily icing, etc.
Thanks again, and hope to hear from you soon. Rich