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Wednesday, April 24, 2013

Sesamoid Fracture: Email Advice

Good Evening Dr. Blake,

I came across your blog and just had wanted some advice. My wife fell off a ladder doing some house work and fractured her sesamoid bone. She has been in extreme pain ever since. We have seen numerous doctors and foot and ankle specialist to help alleviate some of the issues she is having, to no avail. She injured her foot on December 31st 2011. The pain has not stopped since. She is pain medicine but that just dulls the pain momentarily. All the doctors/specialist we have seen seem to be giving us the run around saying things like “this is a complicated situation I really cant help” or its got to heal on its own type answers but no relief from pain. I know sounds unbelievable right. Also she has been in a hard cast for about 5 weeks, then a soft shoe, and now in a boot. Pleas doctor provide some serious help, I hate to see my wife in so much pain.

Dr Blake's Response:

     Thank you very much for your email. Where do we begin? Sesamoid Fractures are normally treated for a year  and then removed if the problem is not responding. Therefore, due to the length of time you are a candidate for surgery. But, if you want to attempt to avoid surgery, over the next 3 months I would do the following:

  1. Get a current MRI to check the status of the healing.
  2. Ice the bottom of foot for 10 minutes three times daily, up to 10 minutes every 2 hours.
  3. Create a pain free environment for all weight bearing activities even if that requires crutches, boots, special shoes, etc.
  4. Make sure the shoes and orthotics that you are wearing do protect the area (go to a shoe store and try on various shoes with your orthotics and feel the difference each one makes at changing the stress through the area---you may be surprised what feels the best). 
  5. Make sure your orthotics have some form of dancer's pad to float the sesamoid.
  6. Get a bone stimulator if the doctor feels that the fracture is slow at healing (I love the Exogen unit from Smith and Nephew).
  7. Since this is a fracture, bone health is critical. Have your Vit D levels drawn to make sure you are in a good spot. Get a bone density screen to see where you are compared to normal. If not already, start taking 1500 mg Calcium daily and 1000 units of Vitamin D.
  8. Analyze what you are doing during the day that really aggravates and avoid that with a passion. 
  9. Learn to spica tape (I have several videos on different techniques within this blog.
  10. Consult with a pain specialist to help reduce the pain level so that you can rehab the leg. If the pain is too great, the patient will not weight bear, and the area gets weaker and weaker. 
I sure hope this helps you get an initial plan at least. Rich 

Enjoying another night at Oracle Arena, home of my Golden State Warriors

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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.