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Saturday, January 26, 2013

Sesamoid Injury Reflare: Email Advice

Dr. Blake,
First off, thank you so much for your Blog.  I've learned more about my injury from you there than I have from any of the podiatrists I've seen so far.  I am hopeful to try your suggestions to alleviate some of my pain.

I initially broke one of my seasmoids nearly 10 years ago.  At that time, I did the whole "orthotics, restrict activity, cortizone shots" etc...  It continued to hurt for several years as I am a very active individual.  Eventually the pain dulled to a mere annoyance, and most days it didn't bother me at all.  However, a few months ago, it started hurting again.  At times the pain is excruciating to the point where I can't walk.  I went to a podiatrist and after x-rays he feels the only real solution is to remove the bone.  My insurance won't cover custom orthotics, cortizone shots or other prescription medications to manage the pain, so I am limited with my options.  I also have dietary restrictions so taking supplements, including calcium, is not an option for me (perhaps contributing to the re-aggravation of the injury?).

I am a dance instructor, and not only do I rely on the income from that, but I'm pretty sure I would go crazy if I had to stop because it is what I love.  My podiatrist assures me that the surgery will be quick and easy, and that recovery time will only be 4-6 weeks.  After 10 years, what are the chances of being able to rehabilitate the bone again?  Are my only options really either surgery or living with the pain?

Thank you for your time,
Sara (name changed)


Accomplishing the impossible means only that the boss will add it to your regular duties. --Doug Larson

Dr Blake's response:
Dear Sara, 

     With your livelihood on the line, and who you are as a person, a dancer, a dance instructor, you owe it to yourself to try to calm it down with 3 months immobilization in a removable boot (like the Anklizer and an EvenUp), along with ice pack 10 minutes 3 to 5 times per day (better than meds), and a bone density screen (you may be needing some bone rebuilding which is a more serious problem). You can buy Spenco insoles and go to www.mooremedical.com and purchase 1/8th inch adhesive felt to build your dancer's pads. If you can get an MRI image like the one below to send me great, but an xray image like the one below made from a Plantar Axial foot image is a great way to interpret things. I hope this helps your thought process. Dr Rich Blake

MRI image of the bottom surface of the first metatarsal showing the tibial sesamoid inflamed but no metatarsal involvement making the injury more serious.

Plantar Axial Xray showing two normal sesamoids under the first metatarsal

     

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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.