Dr Blake's comment: The bone stimulator definitely clouds the picture since it will increase the bone metabolism for healing, making the stress fracture bone reaction seem unchanged. So, as long as you can keep the pain level between 0-2 you try to increase activity gradually at this point. I typically love the bone stimulator for 6-9 months, well after someone is back to full activity.
Dr Blake's comment: Tell her that it is the sesamoid pain we want to avoid, and protect with dancer's pads, and the other pain we need her to work through. Unless the pain is consistent, you almost have to ignore it. Her nervous system is on such high alert for any pain whatsoever, that pain is now magnified. Children always have a problem differentiating between good and bad pain, and in this scenario, any pain can seem bad, which triggers inflammation and compensatory gait and muscle activities. Some physical therapists are just wonderful in this world.
Dr Blake's comment: You are definitely thinking along the same lines as I, although I tend to work more with PTs knowledgeable in biomechanics.
And the patient response 7 weeks later.