Tuesday, August 29, 2017
Avascular Necrosis of the Tibial Sesamoid
Dear Dr. Blake:
I recently commented on one of your blogs posts on PodiatryToday.com, before I came upon your blog. You seem to know much on the subject of sesamoids and their issues, more so than any doctor I’ve encountered.
I’m a 20-year-old college student with avascular necrosis of the right tibial sesamoid. I was diagnosed with stress fractures in my right foot 4 years ago, and when those failed to improve, I was eventually diagnosed with AVN 2 years ago by an orthopedist. He put me through conservative treatment (orthotics, carbon foot plate, Exogen bone stimulator) for a few months, but my symptoms persisted. He recommended surgery. I sought a second opinion from a podiatrist, and he recommended that I continue with whatever conservative treatment I was already doing. So here I am still doing the Exogen bone stimulator every night and wearing orthotics in my sneakers (or dancer’s pad if I’m barefoot). I ice when there’s pain; sometimes I do a hot soak with Epson salts. I was an avid runner before I was diagnosed and have since quit because I still have pain when I run. I’ve found solace in swimming, rowing, and weight training but still sometimes get pain when rowing or going for long walks/hikes.
Long story short, my problem has steadily worsened over the past 2 years, and I was led to believe that it would continue to worsen until surgery was the only option. Reading your blog suggests otherwise though. In other emails from people with AVN of the sesamoids, you discuss treatment options that my doctors never mentioned, mainly spica taping, dry needling, contrast baths, foot mechanic evaluations, Neuro-Eze, bone density/Vitamin D screenings, and CT scans to check for bone fragments. You also say that the chance of the injury re-occurring is very low in the case of the 14-year-old Irish step dancer, whereas my doctors told me that I would have this injury for the rest of my life with no hopes of improvement.
But is there still hope for me, 2 years after the initial diagnosis? Is it common to have this injury for so long with gradual worsening over time? Is it still possible to reverse the effects this late in the game? I know you can’t answer specific medical questions over this forum, but do you have any words of wisdom for a frustrated young athlete?
Thank you for your time.
Dr Blake's comment: Thank you so very much for reaching out. I would love to tell you some positive words, but there is so much we need you to do to find out what is really going on. I have to assume you have good bone density and overall healthy. Definitely if you want me to help you need a CT scan (your Primary can order) and a bone density screen. Also, this should be sent to me with your current MRI (within 6 months). They can be mailed to Dr Rich Blake, 900 Hyde Street, San Francisco, Ca, 94109. I do no charge for this. I hope I can help. Rich