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Saturday, April 12, 2014

Sesamoid Fractures: Email Advice

Dear Dr Blake, 

I have had broken sesamoid bones in both feet for over a year! I've had a bone stimulator since December (4 months) and the pain comes and goes. I am trying not to have surgery but I have just had it at this point. I've had heel spurs and they treat me as if I am avn (avascular necrosis). I have been to 2 different doctors at this point and I just don't know what to do.

Dr Blake's comment:

     Thank you so very much for your email. I have had several patients in your situation who have opted to try to avoid surgery. Classic orthopedic logic would have you have the sesamoids removed and move on with your life. And, no one would blame you for that. Surgery on the feet is difficult with many decisions to make (for example, one foot or both feet at the same time with surgery, will you have permanent disability post op, how much physical therapy will your insurance allow, etc??) Personally, I try to avoid surgery on these important bones, but it is hard for you if you do not have a partner in healthcare to team up with you in this process. Typically, you need to continue twice daily using your bone stimulator, eat healthy with Calcium and Vit D supplements if necessary, get a baseline MRI and CT scans if possible. The CT scans are better at deciding on AVN (dead bone) or not. Ice twice daily and every other day do a full contrast bath for deep flushing. Get foot inserts and shoes that make your walk comfortable, pain level 0-2 max, which will allow you to do much needed protected weight bearing. Without good weight bearing daily, even in a removable boot, the joints freeze up, the ligaments can tight, the muscles weak, and the bones demineralize. Every day that passes without flareup means your sesamoids are getting healthier. The fact that the pain comes and goes is a good sign. Email with other aspects of your history. I hope this helps some. Rich

I have tried to email back on your blog, but it is not working? I have now been to a 3rd doctor and he had me just take a CAT scan. My question is if I do have AVN, how will the bone stimulator still help me? Also I do have orthotics, but I have flat shoes from the podiatrist, what do you feel is better to wear? This all started by running 3-5 miles a day on the concrete. I ran literally almost every single day. I have very arched feet I guess, or so I have been told. I at this point feel my feet will never be the same.  I appreciate your time very much, thank you.

Dr Blake's response:

If you want to send me the CD of the CT I would be happy to look at it. Bone Stimulators are perfect for AVNs that have not fragmented. If the CT Scan shows the bone in multiple pieces, then surgery is your best choice. Orthotics in some sort of shoe that seems to protect the sesamoid area would always be the best bet. With flat soles shoes, if you can not wear orthotics in them or some sort of accommodation, there is too much pressure on the sesamoid area. 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.