Tuesday, September 19, 2017
Sesamoid Injury: Email Advice
Hi Dr. Blake,
I am a 24-year-old, healthy female. Last month I was on vacation with my sister for 3 days and we walked about 5 miles each day. On the last day of vacation, the ball of my foot started hurting gradually, no big deal. The next morning, the pain woke me up and it was extremely swollen. It did not improve so I made an appointment with a podiatrist for.
The podiatrist did an X-Ray and explained some foot anatomy to me. She said it looked like I had a bipartite sesamoid bone because though it was in two pieces, the pieces looked smooth rather than jagged. She then said that on the very edge of one of the pieces, she saw some shading in the X-Ray. "I'm not sure it's a true fracture, but we're going to treat it as one so you can get feeling better."
Dr. Blake's comment: This is the right idea. You are forced to treat the worst case possibility since under treating sesamoid injuries can be harmful to you.
She wrapped my foot in a compression wrap and gave me a walking boot. She said to stay off it as much as possible (crutches or knee scooter) and to come back.
My 4-week appointment was, and I guess I was expecting that I would be done with all this. She did another X-Ray, poked around my foot to see where it was still painful. It does still hurt a bit, but only when I walk and maybe only 25% as much as it did at first. She told me I could begin walking regularly with the boot and ease into tennis shoes.
Dr. Blake's comment: Sounds wonderful so far. The off-weighting can make swelling collect in the tissues, not be pushed out by weight bearing, and the pain worse even though the injury is healing. This did not happen to you, so I feel blessed. Need to get into some dancer's pad arrangement in your shoes to wean out of the boot, but still be protected. It can take several more months to wean out of the boot, so bring it with you wherever you go.
I did some walking around the city this past weekend in my tennis shoes. It did hurt a bit - also on the outside of my foot where I think I was putting more pressure. I decided to go back to the boot. I have another follow-up in 4 more weeks.
Dr. Blake's comment: Smart, see if you can get an earlier appt to start the design of off-weighting it. Remember that there are 3 types of pain at play in these situations: mechanical (so off-weighting helps), inflammatory (so icing twice daily for 10 minutes, and a 20 minute evening contrast bath for deep flushing), and neuropathic (so non-painful massage to the tissue and gentle range of motion of the big toe twice daily for 2 minutes is great).
Long story short, I started reading about sesamoid injuries today and I guess I didn't realize how serious they could be. I'm reading horror stories of how it never heals for some people, and I'm panicked thinking about the fact that I could go the rest of my long life without being able to run, or jump, or even walk comfortably!! I have a history of anxiety and this is a lot to bear. I just want to get back to normal.
If you have any words of advice or comfort, I would be glad to hear them!
Dr. Blake's comment: You sound you are in good hands, and you are responding wonderfully. Create that 0-2 pain level, gradually wean off the boot, work on the 3 levels of pain daily, and read the general rules of sesamoid fracture treatment. Get an MRI if possible because that can be followed better than x-rays. If you get an MRI it will be clearer what you have, and another MRI can be done if needed 6 months down the line to check progress. Good luck. You are doing good right now!!