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Tuesday, November 27, 2012

Sesamoid Injury S/P Surgery: Email Advice

Okay any help would be appreciated. 5 years ago I had a stress fracture in my sesamoid bone The one Under my second toe. I continued to work out on it and the pain went away.
Dr Blake's comment: You have two sesamoids, extra bones like kneecaps, under the ball of your foot (sub first metatarsal head). One of them is closer to the side of the foot (tibial or medial sesamoid) and the other is closer to the 2nd toe/metatarsal (lateral or fibular sesamoid). It was probably the lateral sesamoid that you injured. 
You can imagine the irregularity in the sesamoid that is injured here showing bone remodeling and some break down. 

 About a year later it came back with a vengeance . I tried conservative therapies for a year. Boots, rest, massage, cortisone. Well the bone had necrosis and was completely removed.
Dr Blake's comment: Sound like you did the right thing. Once a sesamoid is removed, the other sesamoid is now more prone for injury and requires a lifetime of dancer's pads and/or orthotics to off weight the area.
A blue dancer's pad is easily applied to the shoe insert that came with the shoe to off weight the area. 

 Everything was fine and pain free. About 6 months ago I was barefoot trying to get a door open and kicked it hard. I fractured my other sesamoid in the same foot. So stupid of me! It is Once again not healing. I don't know what else to do. It hurts to walk. I am 29 very active and in good shape. I know having the other sesamoid removed can cause problems, but do I have another choice? For this current fracture have tried rest, ice, cortisone, and A boot.  Any help would be appreciated. I am scared and frustrated. 
Dr Blake's comment: Get an MRI now to document the bone edema in the sesamoid and possibly first metatarsal head. Create a pain free environment with boot and off weight pads, crutches if needed, possible RollaBout for prolonged standing, make sure your calcium and VitD are great, get a bone density if any suspicions about bone health are raised by your PCP, 3 times daily do 10 ice pack and/or contrast bathing, avoid cortisone and all anti-inflammatories (NSAIDS can slow down bone healing), use the next 3 months to create a good athletic and dress orthotic that protects well, get a bone stimulator to use daily, use the next 3 months to find shoes that limit the pressure on the area. Goals: 3 months to get the above accomplished and hopefully bring down the pain 90% or so, and use the next 6 months to gradually remove all the protection, one piece at a time biweekly. 6 months after the new MRI you get another MRI to document treatment success and decide how much more to do. I sure hope this gets your next 3 months organized. Keep me in the loop. 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.