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Friday, September 2, 2016

Sesamoid Fracture: Email Advice

Dear Dr. Blake,
Good evening!
Happy almost Labor Day weekend!!!!!
  I hope this email finds you well.
 I have a few quick questions.  When you get a chance, I would enjoy hearing back from you.
1.) What is the typical time frame to wear an aircast for a sesamoid fracture? 
Dr Blake's comment: 3 months, and then there is a 2 to 6 week weaning process from boot to no boot.

 I have received two opinions.  Upon palpation, there seems to be minimal, if no, pain in the area of the sesamoid(s), and also when my big toe is manipulated (flexed and extended).  One Podiatrist says 8 weeks, and another one says its not such a good idea to have an airboot on for so long. He suggested that I wean myself out of the boot soon.
 2.) Is it necessary to go through Physical therapy after the aircast is removed?
Dr Blake's comment: From a lot to none, based on the patient's strength, gait disturbances, swelling, joint stiffness, etc. Some patients need to PT took act as their coach, others are okay going alone. When I am treating the patient, I can assess the physical and emotional aspects and help them.

  My main concern is getting used to walking again, in a sneaker. How does one wean himself back into walking regularly in a sneaker?  Should I give myself baby steps, or just start walking again; of course when the time is right. Dr Blake's comment: Here the doc and PT combine to help the patient, and a good understanding of Good vs Bad Pain.

3.) Does it matter if a sesamoid fracture does not heal? 
Dr Blake's comment: It depends on so many factors, but it boils down to the disability produced, and the possibility of damaging the first metatarsal above. When do you just accept what you have, and when do you keep pushing? Every patient is very individual. 

 I was told that it is protected in the various tendons, and many people walk around, there whole lives, without even knowing that they have a sesamoid break.  
4.) Do you believe in balancing the other foot (non-aircasted foot) with an EVEN UP shoe; which, in turn, provides me with more elevation and symmetry with that of the aircast?
Dr Blake's comment: Everyone needs an EvenUp. Women can get by sometimes with heels shoes to even up this difference.
5.) When does a Podiatrist start to fit for specially made orthotics?  
Dr Blake's comment: I love the patient to wearing the orthotic device the last month in the cast. So, the initial impression for the orthotics devices is around 6 weeks.

 I am assuming it has to be after the Podiatrist feels that adequate healing has taken place. What does one do, in the four week interval, as these orthotics take time to be produced?  I guess one should just wear over the counter orthotics.  Which company do you recommend that most Podiatrists bring their orthotics to be made?
Dr Blakes comment: Each podiatrist has a lab that he is used to, and there must be 50 or so of these labs.
As always, THANK YOU for being so kind and generous in answering my abundance of questions!

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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.