Sesamoid Fractures: Email Advice

Dr. Blake,

 I was so happy to see your blog re: sesamoid fractures.  Everything else I’ve seen on the web has been doom and gloom.

In a nutshell, almost 13months ago, my daughter (a soccer player) began experiencing pain in her toe/foot.  We went to a podiatrist who said she had inflammation of the sesamoid and then gave us some pads and told us that Shannon could continue playing as long as she could bear the pain.  That lasted a few weeks, and then she could no longer tolerate the pain.  At this point, we went to an orthopedic doctor.  She diagnosed her the same, and said we could get a cortisone shot that would last about 6months.  In that 6 months, the sesamoid would heal and Shannon would be as good as new.  We got the shot, Shannon played another season of soccer pain free, until the pain reappeared about 4 months later.  This doctor then gave her a second shot.  This shot was ineffective.  A third shot was offered, we declined, and I found a third doctor.  It was now August, almost 10 months from when she first started experiencing pain.

This doctor ordered an MRI which showed a stress fracture in her sesamoid on the right big toe.  He put her in a hard cast for 4 weeks.  At end he was able to see some healing in the fracture.  She was put into a boot that she wore constantly for 2 - 3 months.  She has had pain even with the boot, just from walking around.  She did have a night where she removed the boot and went to a school dance.  (She’s 13 and has had a “broken toe” for a year and just wanted to be normal for a little bit.  The frustration is palpable at this time.)  Ironically, she said she was completely pain free at the dance, and was pain free the next day.  Two days afterward, however, she was back up to a level 8 and it took a few days to calm back down.

Another MRI was done and no healing since first MRI was exhibited.  (this is 3 months later)

Another round of x-rays was done and no sign of improvement, plus her pain is still constant.  Now, our doctor has asked her to be completely non-weight bearing for another month to see if she exhibits any healing.  We are three weeks into that.  (She cheated again on New Years where she was walking around and playing ping pong.  Again, low pain that night and following day, but two days afterward she was back up to a 7 and it took two days to calm back down.)  I did just get a bone stimulator that she has started using nightly.  It’s from biomet and she needs it on 9 hours/day.

We have become quite frustrated and need to know:
1) Do you think she’ll ever play soccer again?
2)  Is her ‘cheating” days setting her back to square one?
3)  Are we on the right path?
4) How do you make a 14 year-old stick to the plan all the time?
5) What else should we be doing?

Help me …I never thought I’d have a teenager whose bone was unable to heal.  She’s ready to just play soccer again, pain and all.

Thank you for your time,

Dr Blake's comment:

     First of all, I would be happy if you sent the first and second MRIs Fed Ex to take a look at no charge. My address is Dr Rich Blake 900 Hyde Street San Francisco Ca, 94109. I need to know if it is a stress fracture or a complete fracture, and if there is any metatarsal involvement. Definitely, the cortisone shots complicated things giving her a false sense of security, while allowing her to continue to injure herself. The 2 times she was out of the cast and into normal shoes and activities is a wonderful sign that she is healing. Even with a very healed sesamoid bone, the pain can go up and down since the healing process brings with it many painful side-effects: scarring, bone swelling, nerve hypersensitivity, to name a few. I think the best thing right now in January 2015 attempt to move from cast to athletic shoes with orthotics and dancer's pads. She can only do this gradually, hour a day at first, then two, etc. She has to maintain 0-2 pain levels. She has to ice twice daily and do contrast baths (the great bone healer) each evening. Find someone to help with the biomechanics/orthotics. I hope this helps. Rich