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Friday, November 30, 2012

Fractured Sesamoid: Email Advice

Dr. Blake,

I was diagnosed with a fibula sesamoid fracture on my left foot. I feel like I am walking on a golf ball and that is what I call it now. I walk on the side of my foot to keep the pressure off of the ball of my foot but that is causing knee pain and hip pain. 

 The podiatrist that I saw took one set of x-rays sold me cushions for my shoes and arch supports to wear. I tried those for 2 weeks and no relief. When I returned to the podiatrist he suggested since the arch supports provided no relief that I try a cortisone shot. The shot took the inflammation out of my foot,for about a week,  so it felt like the golf ball went away but the pain was more severe since there was not any extra padding on the ball of my foot.

 I returned to the Dr. 2 weeks later and he said there is nothing else he can do surgery is my only option and sent me home. I feel after reading your blog that I really need a second opinion before I let anyone do surgery on my foot. My question is do I get that second opinion from another podiatrist or do I try to see an orthopedic doctor? I am scheduled for surgery on December 28, 2012. Any help or advice is very much appreciated. I have cried with my husband over this whole situation and how frustrated I am please help. 


Kara (name changed)

Dear Kara, 

     Thank you for paying me the biggest compliment allowing the blog to help you. Please cancel the surgery so that the next 6 months can be dedicated to healing, not hoping the surgery can be avoided. I would not focus on the surgery, even though you may go that route in a much more enlightened frame of mind.

     The following checklist should help you focus on what you should be doing over the next 3 months. All of this is in the blog.
  1. Daily Use of Removable Cast with EvenUp on the opposite side. Accommodation if more off weight bearing is needed.
  2. Evaulation of Hormone Levels affecting Bone Healing
  3. Daily 1500 mg Calcium and minimum 1000 units Vit D3. 
  4. Ice 15 min twice daily
  5. Contrast Bathing every evening.
  6. Shoe inserts that take the pressure off the sesamoids (under the first metatarsal), normally with good dancer's padding.
  7. Spica Taping daily to restrict toe bend.
  8. Activity Modification to minimize activities which reproduce pain.
  9. MRI ASAP so we have one to compare to in 6 months if necessary.
  10. No more cortisone shots please since they can delay healing and mask pain. 
Sure hope this helps. 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.