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Saturday, September 3, 2016

Followup on Sesamoid Fracture

Hello Dr Blake

Hope you're doing good.

This is in continuation of the mail I sent you in June,
which was after the initial period of misdiagnosis. (three months from mid Feb to May).

The next 12 weeks (mid May to mid August) I spent with minimal activity, very gradually increasing it but with lot of restrictions and care. Couldn't get an anklizer hence managed with Crocs and sneakers using metatarsal pads and foam / sponge  for padding
I have been continuing with contrast baths (twice daily)
Tying the foot with a bandage at night,which has helped a lot in arresting the swelling and pain both.  

So for the last 8 weeks I've had almost no swelling and pain level 1 to 2 occasionally. 
Yesterday I gave my self a little more liberty and climbed stairs and stood for a longer period of time ,as a result I have pain in the foot and when I walk there is a slight pain where the injured  bone is. Maybe pain level 3,which is better after contrast bathing the foot.

Not begun driving yet.

I have been doing some exercises which I saw on your blog - metatarsal doming,(though I am unable to see my nails so I guess I'm doing it incorrectly).Also bringing the toes together and pointing them outwards and pointing the toes down.

The MRI of the foot was done in March end but did not show a fracture ,it was seen in the x-ray the images of which I sent you when I last wrote. Got a repeat done in end  June, sending you those images with this mail.
Dr Blake's comment: The sesamoid x rays show a fracture or bipartite, not conclusive.

On the whole I'm a lot better but wondering how it will be once I get back to routine  activities in full swing.
Dr Blake's comment: The next 3 months are a gradual return to some activity, as long as you can keep the pain level between 0-2.

When should I get another MRI / X- ray done to assess the condition ? Dr Blake's comment: I can not remember your MRI, but you said it did not show a fracture. If it showed some bone edema, we can see if that is getting better. As close to 6 months between the MRIs is preferable, but not exact.

When can I start driving and increase other activity which involves the foot? Dr Blake's comment: Typically now, hope you have mastered dancer's pads, cluffy wedges, and spica taping. Do you have an orthotic that helps? A stiff post op shoe with dancer's pad is a nice way to start driving, as long as you feel that it is safe. 

What should be the next step in the treatment and which are the specific exercises I should do to strengthen my foot?
Dr Blake's comment: Yes, you are venturing into the re-strengthening phase of rehab.

Whatever guidance  I'm getting is through your blog, and am trying to follow it to the best of my understanding.

Thank you for being there for all of us with distressed sesmoids ,its the most informative site I've come across regarding this problem.

Dr Blake's comment: I am happy to help. A PT should be able to show you the nuisances of these exercise. Take it one month at a month. Good luck!!

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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.