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Sunday, September 4, 2016

Sesamoiditis vs Sesamoid Fracture: Email Advice

Hi Dr. Blake,

I've had an extremely worrisome case of sesamoiditis that has been going on for over 2 years and seems to be getting a bit worse! Over the course of the past 2 years, I continued to run on it because I did not want to stop, but the injury would flare up. I would go through periods of time where I wouldn't run because of the pain and am currently taking another break from running. I went to a foot clinic and they gave me 3/4 length orthotics with dancer pads attached to take the pressure off the ball of my foot but it is not 100% effective. I have also been going to physical therapy but my injury is not going away. I have high arches and due to my biomechanics, my feet have a tendency to lean inward, putting more pressure onto the ball of my foot. I will also add that I have sesamoiditis in BOTH of my feet but it is worse than my left. 

Dr Blake's comment: I do find that high arched feet are the hardest technologically to help. Sometimes you have to consider a full length Hannaford type insert which works well. Please have several versions of orthotics made with someone whom is giving it some thought. 
No healthcare provider has recommended cortisone shots for me, but if I see another, I wonder if it will be. I have an eating disorder and I FEAR weight gain from cortisone shots but hear they are one treatment for sesamoiditis. Do I have other options at this point for healing it without getting cortisone shots? Having a limited ability to exercise has also made it difficult for me with my eating problems. I fear that there is no end to this injury and I will have horrible problems functioning in daily life. I am a college student who will have to walk to classes approx. 3+ miles per day to classes. 

Dr Blake's comment: Any bone injury needs the right nutrients to heal, so your eating disorder may be the issue. I assume you are working with a nutrition expert on this. Have you gotten the minimum of bone density and Vit D3 levels? And, are we sure it is sesmoiditis vs fracture by MRI?
I have some more questions....
Is there a good chance that this is a sesamoid fracture as opposed to sesamoiditis? Would a fracture be worse?

Dr Blake's comment: My thought actually. So, an MRI when you can. 

I saw in one of your comments that after surgery, one must wear orthotics and dancer pads all the time for the rest of their this true for everyone? 
Dr Blake's comment: No, of course, there are so many individual factors: is there functional hallux limitus, is there a long first met, is there a plantarflexed first metatarsal, what is the demands of that activity, etc? To summarize, we want to protect your remaining sesamoid, but need to use common sense. 

My orthotics don't even provide relief in regular athletics shoes, they only work for me in a certain pair of fashion sneakers. If I am limited in what shoes I can wear, what do I do about my professional career someday? Do I bring in a doctor's note saying I have a medical condition that limits which shoes I can wear and take action if I were to receive discrimination based on not being able to wear high heels? What do most professionals who are supposed to dress up do? Also, if I were to get surgery, would I most likely be able to resume running again? 
Dr Blake's comment: Definitely this would be up to the treating doc. Hopefully, a simple dancer's pad will suffice in most shoes. Surgery is very successful, but we are trying to avoid it all together. The goal of that surgery is to allow full activity again. Sounds like you need the orthotics to be better though, and get an MRI. 

Thank you so much, I hope to hear from you. I know this writing is all over the place and jumping from topic to topic so let me know if you would like me to re-write this in a more concise way. 

Dr Blake's comment: I am so sorry I was late to respond. Keep me in the loop. Typically the more we learn now, even if you have to have surgery, the smarter we are after surgery. Rich

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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.