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Wednesday, September 18, 2013

Sesamoid Fracture: Email Advice

Dear Dr. Blake,

First, thank you so much for being available for patients and allowing patients to contact you with all their concerns. I feel so much at ease simply knowing the fact that I will be heard! 

Here's a brief history of my sesamoid injury.

Last year in May 2012, I had missed a step while climbing up a staircase and because of that I hit my right foot on the edge of this sharp step. However, that entire day I walked around bearing the pain and only a day later I found out about the fracture on my sesamoid bone. Photo-1 (attached) shows my fracture.
The fracture line is clearly seen in the medial or tibial sesamoid. 

 My doctor asked me to take care and wear good shoes and also gave me some oral medication. I went regularly..And by August 2012, he said I am all good now since I experienced no more pain on the area under my foot.
So I got back to wearing slippers, trendy sandals n high-heeled shoes, walking barefoot at home, gym-ing, running etc. However, there were sometimes when I noticed some discomfort but it didn't last too long and so I forgot all about it.

It was only two days back (Sept-2013, a year later) that I noticed some weird pain and I got concerned since its been a year and I still notice discomfort there. So i got an Xray done (Attached: Photo-2) and I was taken aback when I saw that the sesamoid bone is in two separate pieces now. I went to the same doctor and he said he'd have to put me on a 3-week medication (since i'm leaving for a trip next tuesday) and he said we'll check how you are once you get back. Else we'll have to get it operated (removed).
Here the sesamoid fracture appears widened. The first and second x rays are 15 months or so apart and there has been relatively little pain in this. 

Now Dr. Blake, I'm concerned. I don't feel good knowing the fact that I'm going to be walking around with a broken bone in my foot. What do i do? Can the bone ever get healed without having to remove it? And am i placed with a certain level of disability for life?

Please give me your advise on this since I'm leaving on a trip as well and I'd be exploring places on foot! Now I'm very worried about having a fun trip and a walk-stress-free life ahead!

Awaiting your reply.

Thanks and kind regards,

Paula (name changed)

Dr Blake's comments:

     First of all, x rays are the worse form of followup on these problems. The bone can look irregular due to increased water content across the fracture, but internally can be really solid. So, relax for now. If you read all my blog posts on sesamoid injuries you will realize you have a lot you can do to help your self. Here are my suggestions to work on over the next 4 months. 

#1 Get a baseline MRI
#2 Make sure bone density is good
#3 Make sure Vit D3 levels are good
#4 Make sure your diet is good with daily 1500 mg Calcium and 1000 units VitD
#5 Ice pack bottom of foot for 15 minutes once daily and also as needed
#6. Learn to spica tape of increased activities
#7 Learn to make dancer's pads to off weight the sesamoids even in heels
#8 Have custom orthotics designed to off weight the area
#9 Use common sense in avoiding activities you know will bother you. 

I hope this helps you get moving in the right direction. Do not be concerned over your new x ray for it does not tell how strong the bone actually is. Rich

The Patient's initial response:

Thank you so much, Dr. Blake!

Your responses have helped me understand my situation better! In fact I feel a lot better, too. I will keep all those points in check. As of this Tuesday, I'm leaving for Europe and I plan to get myself good shoes first and get regular with all the other points.

Thank you again!

Much regards,

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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.