Total Pageviews



Thursday, September 13, 2018

Transitioning from one restriction to less restriction: Email Advice

Hi there Dr. Blake,

 I found your blog while looking for the best way to transition out of a walking boot back to my shoe.  I fractured my Medial sesamoid in my Right foot in March while on the elliptical due to high arches and over-pronation.  Started as a stress fracture which I thought was a soft tissue injury so I treated it that way.  Rest, Ice, NSAID’s, elevation.  No improvement after 2 weeks, so I went to our podiatrist here and she found my fractured sesamoid (my what?).
Into the boot, I went for 8 weeks with icing 3 times a day, NSAID ointment for topical use and elevation at night.  Things looked great at follow-up so back into my shoe.  2 weeks later, it was swollen, red and angry again.  Back into the boot and a knee scooter for non-weight bearing for 2 months.  At follow-up, the x-rays showed the bone was knitting with remodeling on the bottom of the bone. 
   There has been general discomfort in the MTP joint for a month, just achiness and occasional tingling in the sesamoid area.  This is Sept. 11 so 5 months out and I will have the knee scooter until the 21st.   I’m concerned about just going into the boot or my shoe and re-breaking it again.  I do not want to have it surgically removed. 
   If you have any suggestions or anything, I’m open to trying it.  Thank you for your time!

Dr. Blake's comment: Thank you for the email. Improper transitions, like our US sprinters dropping the baton in the Olympics, can be devastating. You have done a lot to help the sesamoid heal in the last 4 months so I will assume it is healing just fine. Sesamoids are very sensitive as they heal, and with high arches and overpronation, you are going to be putting a lot of stress on a sensitive bone for a while. So, the question is how to minimize that stress on the bone. My blog is full of information on the following: dancer's padding, Hoka One One Shoes for rocker, avoid toe bend in general, spica taping initially to help stop toe bend, get some Dr. Jills Dancer's pads for even sandals as they come in 1/4 inch size, while you are waiting for a good pair of orthotics to be made, use the dancer's padding in an anklizer boot. You may need to use crutches initially also since you have been using a knee scooter and putting no weight down. That typically makes the joint more swollen and sensitive as you begin weight bearing. Contrast bathes nightly should help reduce the inflammation. I would get Neuro-Eze from Amazon and rub in nonpainfully for 3 minutes three times a day. You also need to strengthen your foot again with metatarsal doming, single leg balancing, heel raises. I have a post explaining how to build a well or depression to float the sesamoid while still doing exercises.

I hope this helps. Rich
PS. Why no Exogen Bone stim? 


  1. Thank you so much for the information!
    I have a pair of Hoka's and Dr. Jills Dancer Pads on the way to me, and I'm looking forward to using them. I also have a pair of rocker bottom Alegria shoes I am using.
    I was unable to get an Exogen Bone stimulator as my insurance said it is experimental (guess they want to pay for problems down the road) and would not cover it. My podiatrist and I both tried. Gotta love when insurance knows better than our doctors.
    I really appreciate the exercise information too. I've been doing exercise to strengthen the outer hip muscles to assist with the overpronation. I have also just been fitted for Orthotics with the cutout for the MTP joint for my arches.
    I hope I can report back in a few months and let you know how things are improving!
    Many thanks!
    Cristie Quiner

  2. Christe, if you still think you would benefit from an Exogen, you can get a reasonably priced, pre-owned system from Mountain Family Products complete with a warranty.

  3. Does anyone know what coding to use for getting a bone stimulator approved through MODA? They will not give a straight answer (so they don't have to approve it.) Bone has been fractured since March of this year with little to no healing. I've been in a CAM walker for 6 of the 7 months. Just frustrated at this point and scared it will never heal.
    Thank you.

    1. Cristie, you have to call the local representative. Mine is Cory Harrison, works for Bioventus, and he can be emailed at If he is not available, say you want to correspond with Dr. Rich Blake's rep in San Francisco area. Hope this helps. Rich

  4. Thank you so much Dr. Blake! I will do that and let you know how it goes!

  5. OH MY GOSH!!!!! Tiffani Kelly with Bioventus is AMAZING!!!! Thank you for pointing me in their direction! Moda declared the bone stimulator experimental and not necessary in a letter to me just a couple days ago, but Tiffani was able to approve me through their company and I am on my second week of home treatment. I cannot thank you and Bioventus enough!


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.