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Friday, December 6, 2019

Sesamoid Fracture Email Advice

Hi Dr. Blake,

I wanted to thank you so much for recommending hiking shoes to me a while back in August of this year. I was able to do some light hikes and felt comfortable for the most part.

However, I’d like your opinion on my sesamoid and if you think I have a fighting chance of it ever healing. I’d be happy to pay you for this opinion, so please let me know how I can. I’m worried that I may need surgery and I’d love to send you my xrays and mri if possible. Let me know if you accept them via drop box or if you want me to send to you.
Dr. Blake's comment: Yes, please send. You can give a donation on the blog, but none is required. They are sent to Dr. Richard Blake, 900 Hyde Street, San Francisco, Ca, 94109. Email at rlb756@gmail.com when you put in the mail to be on the lookout for. 

Here’s my story: Late September 2018, I was experiencing severe foot pain and decided to wait a week until I would visit a doctor. On October 2nd, I went to a podiatrist and he diagnosed my right foot with a medial sesamoid stress fracture. I was in the air cast for about 8 weeks and then he recommended I use a u shaped pad for offloading in my tennis shoe for two months. After walking about a week in the tennis shoe I experienced a horrible relapse in pain and was unable to walk comfortable. Any weight placed on my foot was painful. I visited them again and they recommended a cortisone steroid injection. He injected it right into my fat pad on the ball of my foot and it did absolutely nothing except cause my foot to swell and increase in pain. After 2 weeks of feeling worse pain, post injection, I decided to get a second option and visited and orthopedic surgeon.
Dr. Blake's comment: Yes, no cortisone injections around bones you are trying to heal. Hopefully they gave you short acting cortisone which is safe for the bones, but really not that effective. 

The orthopedic surgeon said I had lots of edema and that my fracture was still not healed. He recommended me to be completely non-weight bearing for 2 months. I used either a knee roller and crutches for that time. Once the 2 months was up, my pain decreased from a 9 to about a 4 and it has remained a 3-4 since early February this year.
Dr. Blake's comment: Even though non weight bearing is almost never necessary, your case it is was justified since you have to get the pain down to within 0-2 for healing to occur. 

I’ve visited this orthopedic surgeon and another one and received the same recommendation. Use a carbon foot plate and get custom orthotics with a cut out for my sesamoid. I’ve work these since March and though I am able to walk it has not improved. Walking for a long period of time or bending back the ball of my foot (for example, when trying to do a push-up or calf raise) still causes a sharp pain or dull ache in the bottom of my foot to the point I cannot do these activities.
Dr. Blake's comment: When you get an MRI, and I like them early in sesamoid injuries, it is a baseline. 6 months later you typically get the next one to compare. I like going to the same place for both if the quality is great. I like 3.0 Tesla if you can get that, but Saint Francis has 1.5 which is very good. You can ask the doctor reading if it is good quality. Doctors know. So many times at the 6 month interval MRI the sesamoid is clearly only 25-50% healed. At least I can help the patient with their expectations then. 

I’ve told my doctors this and they say to wait it out or proceed forward without recommending any further treatment. I just would like to know if my sesamoid has a chance or if I need to proceed with surgery. Based on my mri please let me know if you think a bone stimulator, contrast bath or if you have any other recommendation would help me to avoid surgery! 
Dr. Blake's comment: Will do!! Rich

Thanks again for your help. Your help is greatly appreciated. 

Regards,

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.