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Wednesday, June 14, 2017

Fractured Bipartite Medial Sesamoid: Email Advice

Dr Blake

My 14 year old son was hit during a soccer game and fractured his bipartite medial sesamoid in his right foot. They are still in the same two pieces but considered fractured from each other.

We know he naturally has bipartite sesamoid a due to an unrelated X-ray 3 years earlier.

He was in a boot for 4.5 weeks but is now in a tennis shoe w custom orthotics.

We are supposed to wait 4 more weeks.
This is a unique injury, and I pray I am doing the right things.

He is resting for the most part. He says he is not in pain in his shoe or if any at a low level.

I would fly to California or anywhere to help him.

You are an expert on these injuries so any advice is appreciated.

He is eating healthy. Vitamin c, calcium, magnesium for calcium absorption, etc.

Should I be icing his foot or anything if he seems to be resting calmly.

Thank you

Dr Blake's comment:
     I am just back from vacation, and alittle jet lag, but I hope this makes sense. First of all, everything sounds fine as you are creating a 0-2 pain level for healing. I am assuming this is all x-ray based decisions, and not MRI, which is fine for now. Make sure you are icing the foot twice daily for 15 minutes and doing contrast bathes for a deep flush in the evening. If he walks with the shoes and orthotics, you should feel that he can walk through his foot, but the orthotics take some of the weight off the sesamoids. If not, the doctor should experiment now with higher arch, dancer's padding, or cluffy wedges. All of this is found in the blog. Once he can walk comfortably for 2 weeks straight, he can start a walk run program. That will typically take 10 weeks, and there should be no increased pain. Once you start the walk run program, you can do sports specific non-running activities, like free throws in basketball, volleying in tennis, etc. Nothing to increase pain. The walk run program is typically accompanied with Hoka shoes and spica taping (as needed based on pain). I hope this helps some. Rich


  1. Hi Dr.Blake , any particular model of Hoka shoes you recommend they have so many eg: Clifton,Bondi , Arahi, Speed goat ? And which fit is better for sesamoid sufferers- regular or wide?
    Would really appreciate an answer on this one.Thanks much.

  2. Hokas: I've tried many models--get a Zappos account and there's free shipping and free returns, so u can try several models and sizes out, with impunity. You can also narrow choices by stability (for overpronaters) or neutral (for neutral or underpronaters). I personally found that the toe box on all hokas, even the wide sizes, are just a bit too narrow/shallow with my sesamoid j-pad orthotic (the soles on hokas are great though, and u might be just fine with the toe box). MBT rocker-soled sneakers (via Amazon) and Altras (nice wide toe box, and stiff soles) are working somewhat better for me. If your sesamoid injury isn't too bad you might also consider trying some Finn comfort finnamics...pricey but worth it, with amazing arch support and rocker soles.


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.