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Saturday, May 26, 2012

More on Sesamoid Injuries: Email Advice

Blogging on Saturday is Email Correspondance

Anonymous has left a new comment on your post "Sesamoid Injury: MRI evaluation": 

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 

Dr Blake's comment:

     Dear Discouraged: Definitely I think an MRI gives you a baseline value of the injury which can be compared to 3 to 6 months down the line if healing is being questioned and surgery anticipated. X-rays also can indicate one of the sesamoids looking weird and injured, whereas the MRI actually shows the damage to the other one, or to neither sesamoid and just the soft tissue or tendons. 

     If I recommend the Exogen for improved bone healing, I normally recommend twice per day and for 9 months, even if the problem only seems to take 3 to 6 months to heal. 

     As the bone heals it can look like mush as it remodels. Again, I encourage an MRI, but only when I hold the possibility that taking another MRI down the line will show us good healing. 

     If you have any bone problem, try to stay away from steroids which can retard bone healing. 

     How have you been doing? Are you feeling much better? X-rays can be poor indicators of actual healing, and need to be matched up with pain levels, and levels of disability to get a clearer picture of what is going on. 

     I sure hope this helps you feel somewhat less discouraged. Rich

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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.