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Sunday, November 22, 2015

Sesamoid Injury: Email Advice

Dear Dr Richard Blake,

I have been experiencing pain for about the last 12 months. I have recently seen a podiatrist who referred me onto an orthopaedic surgeon. They have determined that I have a fractured sesamoid but are sending me for an MRI to confirm (Plain x-rays show an abnormal appearance of this lateral sesamoid, which is lying in two pieces. The fragments are not rounded which tends to suggest that it is not a typical bipartite sesamoid.). I do not know a cause of a potential fracture and cannot remember injuring it at any point. There is no swelling around the joint. When I have a couple of days where I am not too active the pain relieves itself and only hurts when pressure is applied such as going on tiptoes or bending my toe back when walking. When I have been on my feet quite a bit it gets quite painful. My doctor has suggested that I try a steroid injection and possible excision of the inflamed sesamoid fragment. I am a bit worried about having surgery on it as I have heard it can cause even more problems and pain. My question is, as this happened over a year ago is this too late to try relieving pressure and hoping that the fracture would heal itself, or is surgery the only option? What would you suggest in this situation?

Apologies for the question but I would be really grateful for your help as I am quite worried about the whole situation.

Kind regards and thank you,

Dr Blake's comment: Definitely get the MRI and see what it says. You can always start the 3 month removable boot Immobilization even after a year. If you have a possible fracture, definitely no steroid injections. With no swelling, you either do not have a fracture, or the fracture is pretty healed. I know that patients can have pain for many months after the complete healing, since they still have to walk on it. Check out all the many treatments for this conservatively. Hope this helps. Rich


  1. I have been dealing with seasmoiditis in both feet for 8 months, worse in right foot. MRI last July showed edema in both bones in left and one in right.Have tried neumerous orthosis without relief. Podistrist injected short acting cortisone 3 days ago in right foot and pain has become much worse especially at night. Does this mean there is a fracture?
    I have tried icing, contrast, physical therapy, stretching with little progress. I am very limited with respect to walking and take Gabapentin daily for pain. Do you have other suggestions?

  2. Jim, I am answering this way too late and I am sorry. If you want to update, please do so. Dr Rich Blake


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.