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Saturday, January 28, 2017

Slow Sesamoid Healing with Symptoms: Email Advice

This email was sent by a patient gradually improving from a sesamoid fracture with some nerve and inflammatory symptoms. 

Dr. Blake,
Happy New Year!  How are you doing?  I hope all is well with you!   If you have some time, could u help me out with answering a few questions.  Thanks a million!  Tom

1.)    Request for MRI, for the following reasons:

Big toe sometimes feels sore, and when I flex it, I feel a very mild soreness there, and also where the sesamoid fracture is.

Warmth radiating along the entire side of my foot (the right side)

When I stand on my tippy toes, it feels sore on the big toe, and also the sesamoid area (pain level 1-2)

2.)    Can peripheral neuropathy be taking place, and if so, how can we rule this out?

3.)    Can I do physical therapy to strengthen the area, or will this make the break worse?

4.)    Sometimes, the top of my big toe, throbs.
5.) since this fracture was not identified until 6 months later, do I have less of a chance of it to heal?
6.) can it ever heal, and if so, what is the time frame?

Dr Blake's Response:

Hey , I'm doing well. My wife and I just got back from a week in Hawaii, so life is pretty good. Thank you for asking. I glad your symptoms are getting better. You want followup MRIs 6 months or greater apart to check healing, so you should be getting another one soon. Peripheral neuropathy is abnormal nerve sensations, typically on both sides. There is a nerve biopsy they do now on the lateral side of your leg, but I am unaware of what podiatrist do it. No, as long as there is no jumping or impact forces you are fine to get physical therapy. The therapist has to be aware of your fracture and they spend alot of time strengthening the core as well as the foot and ankle. Delayed diagnosis can delay healing, time frames are hard. I use functional guidelines while I wait the 6 months between MRIs. These guidelines include a progression of function: when you can get out of the boot, when you can walk 30 minutes without pain, when you can finish a walk/run program? We should see gradual improvement, and make changes if necessary if we hit plateaus. 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.