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Sunday, January 13, 2013

Sesamoid Fracture: Email Advice

Dear Dr. Blake,

I hope you are fine. Firstly I want to say that your blog is really great. 

I am 28 and female. To talk about my problem I've been dealing with a sesamoid fracture for 3 months. Firstly the doc gave me an orthotic that I used for 2 months but it only had an arch support nothing else.

Then I noticed it is not better at the end of 2 months then I went to another doc who suggested me to put a metatarsal pad on the orthotics. I used it for 2 weeks but it didn't get better.

 Then he put me on aircast and told me to use one crutch on the opposite hand while walking. I tried it for a week and I wore a flex aimed metatarsal sleeve inside the cast. One day I noticed the sleeve avoided the circulation and I felt numbness in my big toe, and it was swollen. So I started to use 2 crutches with no weight bearing at all.

 I put an orthotic with a j shaped pad under it. Now it hurts if I don't keep my feet warm. But coming from my childhood they freezes all the time.

What do you think about no weight bearing?
Dr Blake's comment: The main goal is to create a pain free environment. That is maintaining with a sesamoid injury level 0-2 pain for 3 months. You do whatever it takes to get you there: Aircast, orthotics, padding to off weight, crutches, activity modification, etc. 

About orthotics do I need a metatarsal pad or that j shaped foam?
Dr Blake's comment: You need to see if one or both are better for eliminating or reducing the pain level. Sometimes, I have 3 or 4 pads of different shapes on my orthotics to get the best results. 

Does my situation mean I newly started the treatment and lost 3 months?
Dr Blake's comment: You start the countdown towards healing when you have consistently kept the pain level between 0-2. Sesamoid fractures have some rules, but can also make up there own along the way in terms of time and what is needed to help. One day at a time unfortunately. 

 I am afraid to tape my toe because of poor circulation.
Dr Blake's comment: The standard Spica Tape described in my blog should not cut off the circulation. Definitely use Kinesiotape which seems to be the safest. You can take it off before bed each night to be extra careful. 

And is it bad to move the toes?
Dr Blake's comment: Definitely not, you need to keep the joint from freezing up, the toe version of a Frozen Shoulder. Movement with pain is a different story, but I know you can move them without pain. 

I ll be glad if you can answer me. 

Celia (name changed)
Dr Blake's comment: Sure hope this helps. Rich


  1. My big toe still get swallon when I don't elevate my feet. Can it be because of sesamoid fracture? Or should I seek for another reason?

    1. Thanks for the email. Swelling around the big toe can be from many causes. Swelling alone can be quite normal for some, but swelling with pain should always be investigated. Dr Rich Blake


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.