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Wednesday, July 30, 2014

Sesamoid Fracture with Chronic Symptoms: Email Advice

Dr Blake,
     Thank you for offering to help folks out via email/blog!  I was diagnosed almost 10 years ago with a sesamoid tibial stress fracture in my left foot. It was via x rays and he mentioned a specific x ray was the only one to show the fracture.  I think it was a view into the front of the foot.  Is that a typical x ray view done? 
Dr Blake's comment: Probably was what is called the Plantar Axial xray which is a crucial one for sesamoid injuries. 
 I was in a boot and healed great as I had no issues again up until 8 months ago. 

      I am a very active person and exercise on a very regular basis. I moved to a different city so I saw a different doctor (podiatrist).  At the time, I was not sure if this was even the same foot as before.  He took x rays, said no fracture and plastered both of my feet for orthotic inserts - he did something to the inserts to lessen the stress in the area.  He also gave me a shot of cortisone.  
Dr Blake's comment: And we can assume that this helped resolve the situation at that time. 

     A week or so ago I started having intermittent sharp stabbing pain and then more moderate pain sometimes when walking.  The very sharp pain comes sometimes when pushing off foot to stand and start walking.  It is like level +7 pain.  I reached back out to the first doctor's office and confirmed this is happening in the same foot as the prior fracture.  I am not sure what x ray views the current doctor took and wondered if he might have missed a repeat stress fracture.  Could I have gone 8 months with that? 
Dr Blake's comment: You seem to have weakness in that area. Xrays are less than 50% accurate in diagnosing sesamoid fractures, since they can look irregular forever. You would need a bone scan or MRI to make the diagnosis of what is happening now. If you have been doing well, you have not been walking around on a stress fracture for these 8 months!! The flareup now can be a new injury, or an aggravation of this chronic sesamoid disease. Again MRI first, and if positive, CT Scan to 3D visualization of the whole joint. 

      I saw a great orthopedic doctor for a knee issue in January.  I think he has a partner in his office that is more focused on feet/ankles.  Do you think I should see an orthopedic doctor and should I have more x ray views taken or MRI to correctly determine what is wrong? Does a re-fracture happen often?
Dr Blake's comment: Get the MRI from the doctor you are seeing. If it is positive, ask for a CT scan. Then get his/her advice. If everything sounds logical, and no surgery is being recommended, stay the course. If not, get a second opinion. Never tell the second doc what the first doc said since you want as honest and unbiased a 2nd opinion as possible.
Thank you so much - Angela (name changed)

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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.