Transitioning from one restriction to less restriction: Email Advice

Hi there Dr. Blake,

 I found your blog while looking for the best way to transition out of a walking boot back to my shoe.  I fractured my Medial sesamoid in my Right foot in March while on the elliptical due to high arches and over-pronation.  Started as a stress fracture which I thought was a soft tissue injury so I treated it that way.  Rest, Ice, NSAID’s, elevation.  No improvement after 2 weeks, so I went to our podiatrist here and she found my fractured sesamoid (my what?).

Into the boot, I went for 8 weeks with icing 3 times a day, NSAID ointment for topical use and elevation at night.  Things looked great at follow-up so back into my shoe.  2 weeks later, it was swollen, red and angry again.  Back into the boot and a knee scooter for non-weight bearing for 2 months.  At follow-up, the x-rays showed the bone was knitting with remodeling on the bottom of the bone. 

   There has been general discomfort in the MTP joint for a month, just achiness and occasional tingling in the sesamoid area.  This is Sept. 11 so 5 months out and I will have the knee scooter until the 21^st.   I’m concerned about just going into the boot or my shoe and re-breaking it again.  I do not want to have it surgically removed. 

   If you have any suggestions or anything, I’m open to trying it.  Thank you for your time!

Sincerely,

Dr. Blake's comment: Thank you for the email. Improper transitions, like our US sprinters dropping the baton in the Olympics, can be devastating. You have done a lot to help the sesamoid heal in the last 4 months so I will assume it is healing just fine. Sesamoids are very sensitive as they heal, and with high arches and overpronation, you are going to be putting a lot of stress on a sensitive bone for a while. So, the question is how to minimize that stress on the bone. My blog is full of information on the following: dancer's padding, Hoka One One Shoes for rocker, avoid toe bend in general, spica taping initially to help stop toe bend, get some Dr. Jills Dancer's pads for even sandals as they come in 1/4 inch size, while you are waiting for a good pair of orthotics to be made, use the dancer's padding in an anklizer boot. You may need to use crutches initially also since you have been using a knee scooter and putting no weight down. That typically makes the joint more swollen and sensitive as you begin weight bearing. Contrast bathes nightly should help reduce the inflammation. I would get Neuro-Eze from Amazon and rub in nonpainfully for 3 minutes three times a day. You also need to strengthen your foot again with metatarsal doming, single leg balancing, heel raises. I have a post explaining how to build a well or depression to float the sesamoid while still doing exercises.

I hope this helps. Rich
PS. Why no Exogen Bone stim?