Tuesday, November 10, 2015
Sesamoid Injury Prolonged Swelling Post Healing: Email Advice
Hi Dr. Blake,
I saw your blog and I am praying you could help me. I've been suffering from a sesamoid fracture for about 10 months now and I believe I need some guidance as my local podiatrist has not been much help. I have not had pain my foot for over 7 months, but I have a HUGE issue with swelling. I have decided to try non-weight bearing for 4 weeks, and I feel the foot has not improved. Simple trips to the kitchen, or bathroom in crutches agitates and causes my foot to swell and feel uncomfortable. I see that in your post you talk about actually walking and rehabilitating it and I never thought of that. An MRI was performed and the bone seems to have healed, but I still get inflammation constantly. I'm prescribed 500mg of Nabumetone twice a day, but that doesn't seem to help either. I'm wondering if I should try to rehabilitate my foot by walking in an air cast, or some other method or not. If so, I was hoping you could point me in the direction or create a recovery schedule. Any help would be much appreciated. This injury has spun me into depression since I do not see any light at the end of the tunnel, and I am in fear I'll never be able to walk normally again. I hope to hear from you soon with any guidance or suggestions. Thank you.
Dr Blake's response:
This is not that unusual, but surely very frustrating. There are many reasons that this can occur which can point us to the appropriate treatment. First of all, non weight bearing increases swelling, weight bearing without pain decreases swelling. So, you need to be walking, within reason, to help more the swelling out of the area. Secondly, prolonged nerve hypersensitivity can cause swelling (sympathetic overload). So add massage, as deep as you can comfortably, of arnica, NeuroEze, biofreeze, etc three times daily for 10 minutes to move the swelling. Massage always from the sesamoid area back into the arch (towards the heart). Get some Tubigrip, typically size B or C, from the PTs, and wear 24/7, from the toes to just above the ankle bones. Too high can actually cut off the circulation. Every hour pump your ankles up and down, and wiggle your toes, 10 times to move swelling. Never have your fee on the ground, even small amounts of elevation can really help if consistent. Once a day do a full 20 minute contrast bath, and after drying off your feet, put on the Tubigrip and lay on the ground, placing the foot up on the wall or a couch. For the next 20 minutes, do repeated ankle pumps, 3 every minute, to get the fluid out of the tissue. Let me know in one month how this is going. Rich