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Thursday, September 15, 2016
Sesamoid Recovery: Email Advice
Thank you so much for your reply,I had been waiting for it!
Just to briefly update you ......After I last wrote to you on 22nd August, I increased my activity a bit .I also began to cycle for about 10 - 15 minutes,(taking care not to use the left forefoot for peddling).Hardly have I done that for 5 days and the pain level has really gone up.Sometimes I feel pain in the whole foot and at other times its the forefoot ,including all the toes and the arch .
Feeling quite dismayed at this set back since prior to this I was enjoying a pain free period for a number of weeks.
I am worried that I might have re injured the sesamoid again.Is it so?
Dr Blake's comment: The way you did this you probably only stretched the nerves that run through the arch into the sesamoid. It would be hard to hurt the sesamoid since the weight was not on it.
As for orthotics,I do have soft insoles, wondering if I need a pair of moulded ones? Right now I'm using silicon gel cushioning and foam for padding the area.
Dr Blake's comment: That is really up to the orthotic designer capabilities. The goals are to off weight the sesamoid with arch support (that you can feel) and dancer's padding. The higher the arch, the more the insert should be full length to distribute the weight better.
The Darco Orthowedge, which is a front foot off loader is available ,everytime I've tried it even for a few minutes it has been uncomfortable. Maybe I need to wear it longer to get used to it.
Dr Blake's comment: I have never found that comfortable for patients. You can use Anklizer removable boot with a dancer's padding applied.
Peg assist insoles are available here , do you think those will be helpful?
Dr Blake's comment: Okay to make a dancer's pad arrangement.
Is it better to off load the forefoot or to keep it cushioned?
Dr Blake's comment: Initially we think about major off loading, but need to transition to a little off weight bearing and a little cushion. For the two years following the sesamoid injury, err on more off weight bearing, but we have to gradually have the sesamoids bear some weight. Typically the patients are more protective then they need be.
I have not yet tried taping since the spica tape is unavailable here, is there another way to go about it?At night I tie my foot with a bandage, which has so far been helpful but not with this recent episode of pain.
Dr Blake's comment: Spica taping is only the technique. You could technically spica tape with scotch tape if your skin tolerated it.
During the past four months I've taken ultra sound therapy thrice for 8 days each time,it did help.Would you advise another session of that again?The physiotherapist I went to told me it could adversely affect the region if repeatedly done.
Dr Blake's comment: I only recommend Exogen ultrasound once daily. And, regular ultrasound is contraindicated for fractures. Hope this helps.Rich
Waiting for your advice to my queries.
Thanks and regards