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Wednesday, January 1, 2014

Sesamoid Injury: Email Advice

Dr. Blake,

I am a 50-year-old woman and I work out 5 times a week. I run on the tredmill for 20 minutes each day and then end my workout lifting weights. I used to be a gymnast and 24 years ago broke a sesamoid bone in my left foot. After several trials of everything, I ended up having surgery removing the broken bone. Following my surgery I developed RSD. To remedy this I had daily injections as an epidural for a week. I haven't had any trouble with that foot since.

In October I noticed my right foot started hurting in a similar way as my left foot did. I have a high tolerance for pain and continued running on it, not to mention, wearing pumps and boots with a higher heel. It got to the point where I just couldn't take it anymore, so I went to a local podiatrist in Factoria, WA. He briefly looked at my foot, took a xray, and told me my sesamoid bone was broke into two pieces and was splintered pretty good. He put me in an air cast and scheduled a follow up to evaluate whether surgery would be required.

After that appointment, I just didn't feel confident in the diagnosis, so I decided to go to a top rated podiatrist in Bellevue, WA. Before I went I requested a copy of my xray from the previous doctor, but when I got to my second opinion appointment, no one in the office could open the xray on the CD. Having said that, the doctor had to take another xray. He gave me pads to wear and discussed surgery and available dates. I put my aircast back on and left. On the way home, the second opinion doctor called me and said he looked at my xray as well as his partner and did not see any break whatsoever or any splintering like the first doctor claimed. I have been back for a follow up with the second opinion doctor and have another appointment on Jan. 6th 2013 for a possible cortisone shot. The second opinion doctor doesn't have a clue what it could be causing my pain. 
Dr Blake's comment: This is why you get 2nd opinions to make sure surgery is necessary, but the difference is so enormous, you now need a 3rd. I once had 6 opinions on a personal health issue, and I am very happy I did. Is the Aircast a brace or removable boot? If it is a boot, and if it is not comfortable, use 1/4 inch adhesive felt from to design a dancer's pad for the inside of the boot. 

Sesamoid pad to float the sore area placed into the removable boot. 

My foot still hurts off and on...more on than off. I have also noticed than when I cross my right leg over my left, the bad foot tingles terribly. I had a pedicure before Christmas and the girl working on me massaged my feet and pulled on my toes. It did feel quite a bit better after that, but a couple days ago the pain flared up again.

Today I downloaded a program (OmniVue) that allowed me to open the first doctor's xray. I now have a copy of both doctor's xrays. I compared the two and really don't know what I am looking at. I was able to export the first doctor's xray and save it as an image. Would you be willing to allow me to email the image to you so I can get your opinion on all of this? If so, I would certainly appreciate it.

We are meeting with the first doctor on Jan. 3rd to give him an opportunity to explain himself. I don't want any trouble. I just want to know if my foot is broke or not. My biggest concern is nerve damage and the possibility of developing RSD once again.

Thanks in advance.

Dr Blake's comment:

Thank you so very much for the comment. You can take photos of the xray images (as big as possible) and email to me at

 You should however not get a shot unless you have an MRI which is the best definitive test. You can send me the CD of the MRI and I will be happy to look at.

 If you can not get an MRI, and the xrays not are that definite, I would follow the protocol for a fractured sesamoid which includes 3 months in a removable boot, and a bone stimulator. 

Make sure you are doing well with Calcium and Vit D3 and icing twice daily with contrast bathing once daily. Hope this helps for now. 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.