Sesamoid Injuries: Email Advice

Dr. Blake! Thanks for posting and explaining the MRI of the sesamoid. I found this in search of deciding wether the cost of a MRI will be useful in aiding my tibial sesamoid fracture. I wish I had started doing research earlier. I am learning new things such as using the exogen bone stimulator twice a day instead of the recommended once a day.

I did not see a Dr. for my foot until 3-4 months after the injury. My Dr. put me in an immobilization shoe (which i alternated wearing with a carbon fiber insert in cuter shoes) for 2 months. I had a prolo shot, then arfter 2 months recieved my exogen machine and vitamin prescription. she was going to let me go back to work (with continued immobilization) and made it sound like the 2 fractured peices had mended together on one side.
I grew nervous and just got a 2nd opinion. When I looked at the x-ray...the tibial sesamoid looks like a pile of mush with no defined sides...YIKES!! He put me in a bigger CAM boot, prescribed a steriod, wants me off for another month as well as an MRI. Any suggestions you have for me?? How will a MRI help my treatment??
Thanks! ....Discouraged in Texas Tiffany

Tiffany,

     Thank you so very much for the comment to my post on Sesamoid Injuries. Glad some of the fine tuning of the management is coming across like Exogen BID and the value of MRI in these injuries. You have had some interesting treatments like prolo shots and carbon fiber inserts which I seem to never use. If you can comment on them, I know people would be interested. Does the Cam Walker work better than the immobilization shoe, I assume it does so rarely use the shoe? X-rays are so misleading that I do not trust their role in any definitive way in making decisions. They are part of the picture only. 

     To say the sesamoid looked like mush does not sound appetizing, and I have only seen once. It may be the normal healing of the bone as it regroups and reorganizes. Sometimes osteoblastic activity (bone forming) looks a little chaotic at first, even when it is doing a good job. When you talk to the doctor, discuss CT scanning. CT Scanning just shows bone and will tell you if the bone is normal looking or disintegrated (thus the mush look). If disintegrated, surgery is normally done. You get an MRI in order to get another MRI and perhaps another MRI. MRIs shows what is injured (sesamoid, metatarsal, tendon, etc). MRIs for their true value in these circumstances need to be compared 3 to 6 months from now (the longer you can wait the better) to another MRI to check if things are looking better. They look better if they are healing. If the doctor is not going to consider surgery for the next 3 to 6 months anyway, because they want to see if you can heal this thing no matter what the X-rays show, then get your baseline MRI. If the doc is so concerned with the X-ray and honestly feels you should have surgery, get the CT scan first and discuss the findings together. Get an MRI if you agree to try to avoid surgery.

     Remember that steroids  and anti-inflammatory meds slow bone healing, use cautiously, or just ice is what I recommend. Make sure you develop a plan to protect the sesamoid with your doctor as you go from boot to shoes. This normally requires orthotics, spica taping, dancer's padding, some physical therapy, etc. The same treatment used to prevent surgery at this stage is used after surgery if needed. Hope this helps you Tiffany. Dr Rich Blake