Tibial Sesamoid Fracture: Email Advice

     I was diagnosed by xray with tibial sesamoid fracture May 30,2013. I am 36 y/o and healthy, female. Not sure how the injury occurred.

     I am seeing podiatrist, he put me in walking boot for 3 weeks. Repeated xrays showed fracture was worse and no signs of healing. Then he recommended continue with boot, but non weight bearing for 3 more weeks. On July 11th, diagnosed with Non union fracture, still no sign of any healing or improvement. Podiatrist said to allow another 2-3 weeks, but may walk in boot and see how pain tolerance is. If still no improvement then begin cortisone injections. 
Dr Blake's comment: Typical protocol for sesamoid fracture is 3 months removable boot, with 2-6 weeks weaning out of boot maintaining pain free environment.

     I notice burning pain and discomfort after about 5 hours of working, up and down on my foot. He stated that he has seen good success with injections, I just am not sure that is the route I am comfortable with. Do you recommend cortisone injections or are there long term side effects from them?
Dr Blake's comment: Cortisone shots mask pain and slow healing of fracture. Stay away from shots if you are trying to avoid surgical removal. 

     I have read about surgery, but podiatrist only recommends that as a last resort or failed attempts with cortisone. I am a nurse for a busy Family Practice physician and I need (or my boss) needs me to be back at work asap. She is very understanding but this is very frustrating. Its only been 8 weeks! Any suggestions? 
Dr Blake's comments: You need to stay in the boot for the entire 3 months. This is a no brainer to me!!! During the next month have shoe inserts made that take pressure away from the sesamoid. This will speed up your weaning process, and the device will need to be worn for up to 2 years. Get a baseline MRI ASAP to be used to compare your progress in 6 months. You should be able to work with the boot (or well padded surgical shoe!). 

I have not been told of pads to use, can you get them at medical supply store and at my age do you still recommend bone density testing? Thank you for your opinion, any suggestions or help is greatly appreciated.

Dr Blake's comment: You can order a roll of 1/8th adhesive felt at www.mooremedical.com to make your dancer's pads. You really need to read all the posts on sesamoid injuries in this blog (they are plentiful!!), so you and I can be on the same page. There is diet, bone stimulators, icing, contrast bathing, shoe modifications, supplements, spica taping, etc to help you. There is nothing unimportant about this bone, so it is important to save if possible. I hope this helps you some. Rich