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Monday, June 13, 2016

Sesamoid Fracture: Email Advice

Hello Dr Blake,

I'm 38 yrs old and injured my feet Thanksgiving of 2015. I was doing group fitness classes at my gym that included some high impact on my feet like plyometric lunges and jumping/squats, etc. While the floor is carpeted and well-cushioned, I still ended up with 3 sesamoid fractures. Both on my left, medial on right. 

At first I thought it was soft tissue injury so it was almost 5 months after the injury that I even started to address it. 
I'm seeing a podiatrist who came highly recommended from a great sports medicine practice here in town. 
I am a high arch foot type who lands heavily on my first MT. Left>right. 
Dr Blake's comment: It seems for sesamoid fractures having high arch feet is the worse structure since the first metatarsal is particularly driven into the ground with great force. 

My recent MRI done last week shows osteonecrosis of the medial left. Significant marrow edema of the other 2. 
I was in a boot initially(early April) on my left for 3 weeks which helped some but after getting out of it, the pain quickly returned. 
I've also had custom orthotics for the last month(early May) that so far are not making a real difference. 
At my follow up today she is recommending Bone Growth Stimulator. 
Dr Blake' comment: You definitely want a 9 month course of bone stim to see if that helps. Wait on a new MRI until at least 6 of those 9 months pass. 

I'm also going to have my Vit D levels checked to be sure all is good there. Although my bone density on X-rays appears very normal. 
I want nothing more than to be active the rest of my life and to avoid severe arthritis In my feet. 

Our discussion about surgery left me very discouraged. If she removes the necrotic bone she's concerned about shifting in the joint, and if she removed both, then she talked about fixation of that joint. 
I guess I just wanted to hear that I could remove them and have a fully functional foot after healing. 
I want to be patient, but I also want to know that I'm moving in the right direction. 
Dr Blake's comment: To me, your year of potential healing started when you first went into the removable boot and accomplished a 0-2 pain level. So, be patient, get the Vitamin D, get bone density screen if anyone is concerned, do what you can to weight bear with maintaining the 0-2 pain level. My blog is full of tips. Comment on this blog post. Rich

Thank 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.