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Sunday, August 11, 2013

Sesamoid Fracture: Email Advice

This email was received August 11th, 2013 for time reference. 


Hello Dr. Blake,

My name is Michael (name changed)  and I am in my early 20's. I have been a runner for the past 5 years and I love it. Back in December 2012, I tripped over my big toe (not while running) and knew right away that something was wrong. I went to the doctor to get it x-rayed but, since the metatarsal bone was not broken, my doctor told me nothing was wrong and to ice/rest for a couple of weeks. I did this until the pain was much better and the swelling went away and then slowly returned to running, biking, yoga, and all of the other things I love to do while still incorporating stretches and strengthening exercises I had found online for my foot. 
Dr Blake's comment: I would have to say that from the sounds of things that your original injury definitely healed. 

The pain was almost completely gone (would just have some issues from time to time) until I decided to skate one day in June. I pushed out and immediately felt a sharp pain in the ball of my foot where I had injured it before. After putting it off for a couple of weeks, I finally decided to go to the podiatrist. He x-rayed my foot and immediately found that one of my sesamoid bones was fractured. I have now been in a boot for 4 weeks and have two more to go and when I went back for my half way check up the fracture was still there and I am now on cortisone pills for the swelling and inflammation.
Dr Blake's comment: A fractured sesamoid should be immobilized for 3 months, while an off weighting orthotic is being designed to help with the gradual weaning process of boot to athletic shoe. That process along can take 2-6 weeks. Whatever happens, as you begin to wean out of the boot, you can not have more pain. Hopefully the boot has brought the pain level between 0-2 while you are walking in it. 

Now that you know my story I have a couple of questions. I read on your blog, when used properly, cortisone pills can sometimes help inflammation and pain. This was great to hear and we shall see how they work for me on an individual basis. My main question is this: do sesamoid fractures usually heal and will I ever be pain free again? I am having a very hard time physically and emotionally due to the fact that I am so young and am normally very active. I miss working out and I have not read the best recovery stories about this injury. I want to avoid surgery if possible and my podiatrist is on the same page. I like that is seems you have the same ideas about surgery. I am really just looking for some words of encouragement from an outside source or any positive feedback that you have gotten or seen from a sesamoid fracture recovery. 

I thank you so much for taking the time to read my email and for creating a blog that allows for me to further research what I am going through.

Sincerely, Michael

Hope you will be back running soon!! 


Dr Blake's comment: Sesamoid Fractures are very tricky, but sound principles and patience can get most patients through without surgery. All guidelines to treatment are close approximations/generalizations. You can still heal even if you are an exception. What are the most important points for you right now? 

A) Listen to your body and do not accept more pain as you go from stage to stage.
B) Bones need Calcium and Vitamin D3 to heal, make sure your diet is good.
C) Swelling is your enemy, even deep swelling in the bone which you can not see, it cuts off healing circulation, so icing and contrast bathing daily is extremely important.
D) Typically at 3 months post injury you are getting out of the cast, and 6 months after the injury you are beginning a walk run program, so go slow with each stage.
E) Your podiatrist can begin making an off weight bearing orthotic device now, or modify your present ones, so when you begin to wean out of the cast, you are protected.
F) Avoid all anti-inflammatory meds after you finish the cortisone pills, since many slow bone healing.
G) Even with the boot, you should be riding a stationary bike, swimming, and other core activities that do not put stress on the sesamoid, or force bending the big toe joint. 
H) Ask the podiatrist if you are a candidate for a bone stimulator.
I) Ask if a baseline MRI can be taken, in case you need one in 6 months to check on healing.
J) Learn spica taping and how to make dancer's pads (also called Reverse Morton's).
K) Find out when you should start re-strengthening your foot (met doming, single leg balancing with a hole for the sesamoid, inversion/eversion therabands, etc). 

I hope this all helps Rich

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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.