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Friday, June 16, 2017

Fractured Sesamoid: Email Advice

Hi Dr Blake!

After scouring the internet in a desperate search of hope for my sesamoid injury, i have stumbled across your blog (thank goodness)!

I am dealing with a fractured sesamoid that i believe may have occurred in April 2017. When i originally felt the pain from the fracture, i did not think anything of it , as i have suffered from PF for years ( I am a 24 y/o female ). 

The pain began to increase in my left, big toe, so I finally made the decision to visit an orthopedist on May 12th. I was beginning to worry how my pain would affect my 1 year work trip to an unsafe location in the middle east, where i would be on my feet 7 days/wk , ~12 hrs/day. 

The orthopedist x-rayed my foot and told me, "you have an old split bone in your toe". Because he did not go into any further detail and simply told me to cushion my foot better, I continued on thinking this was an injury i had acquired many years ago from dancing ( and that has simply flared up temporarily ). 

As the pain became more severe, and my time in the US limited to only a few wks, I found a podiatrist. He immediately diagnosed my problem as a fractured sesamoid (left, big toe) and put me in a Cam Walker (which i have been wearing now for about 3 weeks). He wanted to over-treat the injury as he knew i was intending on leaving the US very soon.

I was also given 2 separate EPAT treatments to help with my PF.

Fast forward to my appt. this week, I told him i was  not getting any better and i had doubts that my foot would improve before my deployment. We both decided I should tell my employer that i needed to delay 2-3 weeks and they were OK with that.

My podiatrist ordered an MRI (which i had just a few days ago) and the results are disheartening. It says it is looking like a non-union and i am devastated as i have been planning for months to move overseas for this work trip.. I am now unsure what kind of time-frame to put on this injury and do not think i will be ready to leave in 2 weeks.

I am still in the cam walker (about a 3 pain level, i mostly feel a constant dull ache), i am trying gentle massage, cold/hot therapy, etc. I do get nerve pain/tingling in my toes when i lay down/ sit down. And my big toe has definitely lost its range of motion (which i am now starting to work on).

I am at a loss. Do you think this has any potential to heal in the next 2 months? 

I really don't know what to do at this point.

I really appreciate any insight and thank you so much for your time!


Dr Blake's comment: These injuries can take quite a while (6-9 months) to heal, and if you rush them for whatever reason, you risk starting over. You are in the right boot now. You need to maintain a 0-2 pain level over the next year. You need an orthotic with dancer's padding to off weight the area, and can allow you to get out of the boot faster or get into a Hike and Bike shoe. instead of the boot. These shoes are not to be bent across the ball of the foot in an active pushoff, but are easily adapted by my patients and will protect the sesamoid. So, if you can get a protective orthotic to shift from boot, to Hike and Bike, to normal athletic shoes (consider Hoka One One Bondi), over the next two weeks, you should be well protected and can go on your trip with the Hike and Bike shoes, and a removable boot as a backup. Continue to ice twice daily, and do a deep flush with contrast bathes in the evening. Good luck and I hope it helps some. 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.