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Thursday, December 14, 2017

Sesamoid Stress Fracture: Email Advice

Hi Dr. Blake, 

I was wondering if I could get your input on my situation and whether I should pursue additional treatment for the hairline stress fracture in my left tibial sesamoid.

In February of this year, I started feeling an occasional sharp pain when training for sports and went to see a podiatrist in CT who took x-rays and diagnosed me with inflamed sesamoids. I rested/iced/took high strength ibuprofen for a while, but eventually decided to return to playing frisbee because the pain wasn't improving at all and it was my senior year (and we ended up making it to the National Championship game so I wanted to participate). After I graduated, I saw another podiatrist who took more x-rays and also said it was inflammation but thought I should be fine without orthotics or anything. Just continued rest.
Dr Blake's comment: Golden Rule of Foot: Create a 0-2 Pain Level for Healing. Rest however is very destructive overall in allowing deconditioning, swelling, nerve hypersensitivity, etc. I definitely want a more active approach to heal. 

After stopping all running and resting as much as possible for the summer, I still had pain and a lot of swelling. I saw my third podiatrist here in San Francisco and an MRI showed a hairline stress fracture in the tibial sesamoid (even though that spot never particularly hurt when pressed by any of the doctors).
Dr Blake's comment: Could be an over-read of the MRI for just bruising and inflammation. 

I have now been in a walking boot for 6+ weeks, semi-weight bearing with a crutch for the past 4. There is a pad on the bottom with a cutout for the sesamoid. The sharp pain is mostly gone, but I still get bouts of pretty severe swelling where I feel like all the blood is rushing and pooling in my foot. It gets red and hot and tingly. I also have noticed a general tingling when I touch the ball of my foot and big toe. I also developed more pain on the top side of my foot directly above where the sesamoids are and on the underside of my big toe where it meets the foot. Sometimes it feels like it is bruised there.
Dr Blake's comment: Pain, swelling, tingling, etc. that you did feel until after you went into the boot is probably caused by the immobilization and will get better once you leave the boot. Since your injury is so small, and we are not worried that it is a displaced fracture may be needing surgery, try to alternate environments with boot, hoka one one shoes, hike and bike shoes, and normal athletic shoes with orthotics and dancer's padding. 

To make matters more confusing, I am moving in three weeks and starting a new job right away in Hanover, NH. My podiatrist here hasn't really laid out a plan for me, except looking for a referral for me. I am worried that the walking boot may be causing more issues and the lack of PT or rehabilitation could be slowing my recovery. I am wondering what you think about my symptoms and response to treatment so far, and what my plan should be moving forward. I am also very willing to come see you in person since I will be in the area for the next few weeks.
Dr Blake's comment: Several weeks have passed since you emailed this, so you have probably moved. I hope the idea of alternating environments and daily working on the inflammation and nerve hypersensitivity is helpful. Good luck. 

I look forward to hearing from you and truly appreciate the time you take to help others like myself. Thank you very much!


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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.