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Sunday, June 17, 2018

Sesamoid Injury: Controlling Inflammation while Transitioning from a boot

Dr. Blake,

Unfortunately, like many of the other readers of your blog, I have suffered a non-displaced medial sesamoid fracture in my right foot in November 2017. Since December 2017 I have been in a walking boot. A few months went by, and after making zero progress I started digging for more information and found this blog along with a bunch of other resources regarding bone health. Even though I knew I was getting more than adequate amounts of calcium each day, I started taking Vitamin D in March 2018 and my symptoms started radically changing, and the injury finally started to feel like it was 'healing'. To confirm my suspicion of low vitamin D, I ordered a blood test myself (via, if any of your readers want to get one done without going to a Doctor) and found out my level was at 26 ng/ml. After finding this out, I increased my dosage, and I have been maintaining it around 50-60 ng/ml for about 3 months. 
Dr. Blake's comment: Thank you for the info on Vit D testing. 

Over these last 3 months, the pain has been primarily due to the inflammation and blood flow going to my forefoot, which I have been able to mitigate by keeping my foot elevated and icing it occasionally. I've done a decent job maintaining a 0-2 pain level as you suggest, and I feel like I am able to slowly transition out of the boot. At this point, I am able to (in the boot) put more weight through the ball of my foot simply because the inflammation is a lot milder than it was 3 months ago. My main question is, as I transition into a stiff-soled shoe with orthotics, what are the primary signs to go back into the boot temporarily?
Dr. Blake's comment: You have to maintain the 0-2 pain levels throughout. Look for patterns of what increases your pain and avoid for one month before retesting that benchmark again. As you transition from boot, you should ice twice daily whether or not you feel you need it, and contrast baths each evening. 

 During this transition period and after the transition period, is it common to have the area swell up still? I just want to get a good idea of how much inflammation I am supposed to expect as I transition into walking normally, and then transition into jogging and running months down the road.
Dr. Blake's comment: Swelling produced by an injury is a bell-shaped curve. Some people swell a lot and others don't. Swelling per say is not that important, but pain is. So, if it swells, but does not hurt, no big deal. But, the icing and contrasts and nonpainful massage are important on a daily basis. Good luck. Rich

Also, I want to say thanks for starting the blog, it looks like it has grown quite a bit and it is jam-packed with a ton of good information. I am making a donation for sure.


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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.