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Monday, November 16, 2015

Sesamoid Fracture: Email Advice

Dear Dr. Richard Blake,

First I would like to express my gratitude: you have been very special by sharing your knowledge, by motivating, and by being very clear to all of us who live far from you.  

Let me try to be concise with the injury: After 2.5 months under small and constant pain, I got both X-Ray and MRI to check that out following doctor's prescription:  "Vertical fracture line in the medial sesamoid in its central portion.  Associated with edema and inflammatory process, probably from stress.  No evidence of Avascular necrosis".  I believe it happened due to a combination of factors, first bumped my foot while bicycling, then overused it while climbing with a tiny climbing shoes, and from there on just wearing cowboy boots and all that... I got the diagnosis 2 weeks ago and so far I have been doing all what the doctor prescribed to a conservative treatment.      

I have 4 questions that hopefully will also help the understanding of many  readers/patients:

1) A lot of us have been wearing boots, cast, or even orthopedics pads, so the question is, what about the baruk shoe, don't you think it may be a better option to avoid the contact of the ball of our foot on the ground?  What about if I get to be on wheel chair for 1-2 months to avoid the contact of the entire foot, wouldn't that be good idea to heal the bone faster? I attached a picture of the baruk shoe then you could gently share with your readers.
Dr Blake's comment: Thank you very much for this comment. I am very much into weight bearing for swelling reduction and bone mineralization, but there is a place in the course of treatment for the Baruk shoe or Darco Orthowedge to totally off weight the area at times. It is all about maintaining the 0-2 pain level. I believe in weight bearing an injury for the bone and muscle strength, along with swelling reduction.

2) Do you think swimming can be a good exercise to release tension as well as to enhance blood flow in the area?
Dr Blake's comment: Definitely, without pushing off the wall with the injured foot. 

3) Do you think warm/cold contrast bath can be good?  If yes, how would you propose us to do: how many minutes in each warm/cold bath, and how many times in total in each session? Dr Blake: see link below.

4) We know each one of us has a unique injury, where healing time will be processed differently due to many factors, but if we take an average, how long would take to heal from a general stress fracture? 
Dr Blake's comment: 8-12 weeks to allow the fracture to heal, and another 3-6 months to remove the nerve sensitivity and swelling. Some depends on whether you have to walk on the fracture area which definitely increases the symptom longevity. 

 More than that, do you think we can really get healed without surgery?  It seems impossible to find a successful story, making me very sad.
Dr Blake's comment: Sesamoids heal 95% of the time. Good odds. I really need to push my patients who get well to tell their stories. Only 1 in 20 go on to surgery. 

I wanted to thank you in advance for your help, and coming to the Bay I will make sure to get an appointment with you.


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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.