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Monday, November 5, 2012

Fractured Sesamoid Bone: Email Advice

Hi Dr. Blake, 

I have been dealing with a fractured seisamoid for several years now. I have seen orthopedic surgeons and a podiatrist that works with an Ortho group. I have had x-rays and an MRI confirming that it is fractured. I wore a walking boot for 5 very long months. I have taken anti-inflammatory medications, I have had an annual cortisone injection (which last about 6-8 months and then I tough it out). I have tried to have custom orthotics made, and every time they make me a new pair, it causes another area of the foot so much pain that it's worse because two areas hurt. I have heard a metatarsal sleeve is helpful. 

I used to be a recreational runner, but have not had that pleasure for about three years now. I do live near the mountains in Colorado, and I love to hike. I have found that shoes with stiff and rigid soles help, and I have stopped wearing heels except for an occasional special occasion like a Christmas party. I have a VERY high arch. 

My doctor is at the point of surgery, but I am terrified that all I will be doing is trading one pain issue for a host of pain issues, and that I won't even be able to hike. I have NEVER read anything good about that surgery or it's success. 

Is it possible to get a shoe insert made that is very hard & stiff to make even softer soled shoes more rigid? 

I am desperate! 


Dr Blake's comment: 

     Dear Sheila, The most important question right now is whether you have injured the joint (a condition called Hallux Rigidus). The three possible reasons you could have injured the joint are A) time with an unhealing injury, B) using cortisone to mask the pain (especially repeatedly), and C) the fractured sesamoid injuring the first metatarsal since the fragments irritate the joint. 
     I would recommend you see Dr William O'Halloran or Dr Thomas Shonka in Colorado. Both are wise podiatrists, both are my friends. You should have a recent MRI and xrays. The joint can be easily assessed. If damaged, the surgery discussion is focused on removing the injured sesamoid and somewhat fixing the joint. 
     Definitely, get this info first and see what you are dealing with. I do not recommend sesamoid fracture removal without an MRI. When the joint is healthy, and the symptoms and story as long as yours, I would have no problem recommending surgery. The surgery is not perfect, the disability is 90% better than before surgery, but  you could be in the 10%. I would not hesitate to have surgery and take my chances after this long. 
     If the joint is unhealthy, you need to assess pre-op anyway. You still remove the sesamoid, but the joint must be helped also. It may require a second surgery. You may require 2 different procedures at the same time. There are several possibilities, which all stem from the initial MRI. 
     I hope this gets you pointed in the right direction. Rich Blake

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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.