Sesamoid Injury: Email Advice

Hello Dr. Blake,

 I am a 26-year-old female from Windsor, Ontario, Canada. 

I am struggling with a fibular sesamoid injury which occurred in January 2018. I read your posts regarding sesamoid injuries on your blog and found them very helpful! 

I've had two x-rays, a bone scan, and an MRI so far and unfortunately, I have not been able to get a clear answer from the health care professionals here in Windsor. The radiology reports from both of the x-rays and the MRI indicated no fracture or focal bone lesion, however, I have gone to see three podiatrists who all claim that there is a fibular sesamoid fracture. The report from the MRI (which I finally had in May 2018) stated that there was lateral sesamoid bone marrow edema and the conclusion was sesamoiditis. One of the radiologists also thought there might be a "crack in my big toe." 

Dr. Blake's comment: Sesamoiditis with bone edema can be the same treatment and injury as a stress fracture. You can not see a small stress fracture, but it causes bone edema as your body attempts healing. So, they can look the same, and we are really forced to treat the possible fracture because that has long-term complications like the need for surgery that we want to avoid. 

I admit I did not stay off of my foot when I was originally injured in January since the diagnosis was unclear. I am very active and do a lot of walking at work (sometimes wearing heels). However, despite staying off of my foot for the past month I am still in a lot of pain and have not seen improvement. I am also struggling with circulation issues (despite trying contrast baths). I am wondering if there is underlying etiology that may have been missed. 

Dr. Blake's comment: For bone health and tissue strength, along with swelling reduction, weight bearing to tolerance is crucial. Yes, you can not push through pain, but rest (getting off your feet for an extended time, does not help either. 

Due to our healthcare system in Canada, I am not able to get in to see a specialist until September 2018. I was wondering if you would be so kind to have a look at my MRI or x-rays and give me your clinical opinion? I could mail or e-mail them to you and I would be happy to pay you for your time as well! Please let me know if this would be okay with you. 

Dr. Blake's comment: Yes, please mail a disc to Dr. Rich Blake 900 Hyde Street, San Francisco, California, 94109. No charge for this. Contact my friend Dr. Shannon Frizzell at OOLAB (Ontario Orthotic Lab) in Hamilton, Ontario to see how you can get a good orthotic to protect the sesamoid. 

Thank-you for providing such thorough and detailed information on your blog. It has helped me immensely so far! 

Thank-you for your time,