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Sunday, July 24, 2016

Sesamoid Fracture: Email Advice

Hi Dr Blake

I discovered your blog/YouTube channel after conducting my own research on my fractured sesamoid bone. I was first diagnosed with this injury 1 month ago when I went to the ER for an X-ray. The ER doctors acted like it was no big deal and told me to follow up with a podiatrist.
Dr Blake's comment: Feet injuries are typically never life threatening, so if that ER doc had just saved someone's life suffering a cardiac arrest, your injury may have seems not that important at that time. 

 I saw a local podiatrist the next week and they put me a in cam walker and told me the fracture would heal it's self in a few weeks. 
Dr Blake's comment: I am sure my sesamoid patients would concur that typically 3 months in the boot is important, followed by 2-6 weeks of weaning out of the boot into shoes with orthotics and dancer's pads to off weight the area. 

They wanted to see me for a follow up after being in the cam walker for 14 days. At this appointment I got the bad news that my fracture had actually gotten worse. The doctor then told me that I was back to square 1, no weight bearing, crutches and to wear my flat walking shoe that the ER had given me. This new treatment plan really confused me and that is when I started to do my own research and discovered you.
Dr Blake's comment: Following these injuries by xray is very difficult. Xrays show the amount of calcium in a given area. When an injury is flooded with healing body fluid bringing in calcium, etc, to the wound site, the relative amount of calcium is less and the fracture looks worse. This would be usually the wrong interpretation of that xray. Yes, the fracture could be worse, but it is not typical unless you fell or had a high impact stumble while in the boot. By 2 months into the injury, the xrays are supposedly 2 months behind demonstrating the actual injury healing. What good are they after the initial diagnosis, unless there is a fall, etc? If I only had xrays to image, I would wait 4-5 months to get repeat xrays. 
I have 2 small children and we are extremely active. I jog, bike and weight train 5x a week so I need to heal this completely. I'm committed to doing whatever I have to and know that it is going to be a long road to recovery.
Dr Blake's comment: You have to listen to your body. As long as you can keep the pain level in the boot from 0-2, typically this is a weight bearing injury. I can not overstep the treating doc, of course, but I find non weight bearing causes more swelling, more pain, more bone demineralization, and slower healing typically. 

I'm currently on day 4 of zero weight bearing. I've been icing and elevating. I have
an appointment to see my podiatrist, but I think that I need to find a new Doctor in the meantime. It seems to me that he doesn't know how to treat this specific injury and is not giving me the correct information on how to heal it. I am going to start the heat/cold baths you recommended tonight. My other questions to you are do you think that I should continue to be non-weight bearing or do you think I am ready for the cam walker with the dancers insert? My doctor seemed to have no knowledge of the insert and seemed to treat it as any old fracture.
Dr Blake's comment: You have to feel comfortable with your treating doctor, and I am sure he means well, and because of the caution going to non weight bearing, you will heal fine. There is no research I have seen on non weight bearing vs weight bearing, but definitely get another opinion. One good place to start is the AAPSM website. Go to their member's list and see if one is near you. These are sports podiatrist who typically are conservative, and are very familiar with this injury. If she/he says the same thing, you can choose to go to whomever. Read all my posts on this subject. 

I'd greatly appreciate any input you could give me. I'm only 28 and as I've mentioned I have children so I'm just very worried about having to suffer from this for years to come. I will be donating to your cause and I look forward to hearing back from you.
Dr Blake's comment: Thank you so very much for that. I wish you well and you can comment on this post or through the email at any time. Rich

Thank you for your help.

Sadie Zeuner


  1. Dr Blake,

    Thank you so much for your quick reaponse. I really appreciate you getting back to me. Unfortunately there are no AAPSM members in my area. I am going to try and get an appointment this week with an orthopedic doctor who was highly recommended to me. I am anxious to get back in the boot. At this point 3 months in the boot sounds better then 3 weeks on crutches. My inflammation has increased tremensly since I've been on the crutches. I've been contrast bathing followed by super elevating 2x daily which seems to be helping. Should I be ending the contrast bath with heat or cold? I remember reading that at some point but cannot seem to find it again. Also when I get back in the boot do you recommend me inserting the dancers pad immediately? And is there a certian kind or brand that you prefer?
    Again thank you so much for your help!

    1. Always end contrast bathing with ice, typically one minute, however there are times that you feel more swollen with the contrasts, so then ice for 5 minutes. Yes, boot and dancer's padding go together like a horse and carriage, or soup and sandwich. You can use any material to make a dancer's pad. See images on the blog. You can get a pair of soft shoe insoles and cut out a dancer's pad to float the sore area. Hope this helps. Rich

  2. I saw an orthopedic podiatrist yesterday for a second opinion. I was not that impressed. He told me it's fine to walk in the boot which is good but that I didn't need padding or the evenup. I went ahead and ordered the Dr Jills dancers pad and made my own until that arrives. I'm also going to do minimal weight bearing until then. His main concern was for me to not move by big toe but he told not to tape it. I'm worried that I move my big toe when walking on my heal in the boot. I also feel like my big toe has muscle spasms and moves itself sometimes. I just want to do everything possible to get this healed and not waist any more time!

    1. Spica taping is more important when you are out of the boot, but every treatment modality has to be individualized to you. By that I mean you should try it and see if it helps you or not. If you really can not tell whether it helps, try taping every other day, and see if you can notice a difference. If not, save it for when you are out of the tape. All docs will use generalizations which may or may not apply to you. Hope this helps Sadie. Rich

  3. I am about a month into recovery now. I have the pain to a 0-2 in the boot with a dancers pad and about zero pain when non weight bearing. I'm pretty sure I reinsured last night. I accidentally stepped the wrong way putting weight onto the ball of my foot instead of my heal and felt a crack. The pain is not unbearable but back to where it was. Any advice?

  4. I'm also wondering your thoughts on swimming and biking?

  5. I saw my doctor this week and the X-ray showed no healing. He started me on a CMF bone stimulator. Do you have any opinion on this brand? I was getting ready to order an Exogen from EBay but he gave me this one for free. Every time I get the pain and swelling down I some how manage to re-injure. Last month he gave me the okay to swim and stationary bike but I'm pretty sure that aggravated it. Pain and swelling are worse then day 1 and my whole foot is purple in the evening. I am now about 9 weeks into recovery with no progress. My big toe is also starting to freeze up. My doctor stressed for me not to move it at all and that it wouldn't freeze but his student was concerned when I could hardly move it. I feel I've been doing every thing right. Dancers pad in the boot, daily contrast bathing, daily ice and elevation, supplements and I stay off it as much as possible. I feel like my only hope at this point is the bone stimulator. Any advice would be greatly appreciated.

  6. Hi Sadie , hope you are recovering well.How are you now?What shoes are you wearing , are you using a bone growth stimulator?


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.