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Saturday, March 9, 2019

Sesamoid Fracture Treatment: A hope to avoid Surgery

Hello Dr.Blake!

I am happy I found your blog post about fracture seasmoids. I’m hoping to get some advice or maybe just some encouragement!

So here goes! I am pretty active and enjoying hiking, running and workout classes. I suffered from turf toe back in 2016...after therapy and taping it got better. A few months later similar pain returned and it was diagnosed as sesamoiditis. Last year we found I had a complete fracture of my medial seasmoid. I was put in a walking boot for 6 weeks and the pain went away but fracture didn’t heal. The podiatrist told me to leave it alone if it didn’t hurt. Fast forward to a few weeks ago when I finally got a second opinion and I am now non weight bearing and using a bone stimulator twice a day. My biggest question is this, do you really think that after a year this fracture could heal without surgery? I’m pretty skeptical.
Dr. Blake's comment: Depends on the gapping or the fragments, the amount of avascular necrosis that has sent in, the biomechanics of your foot and activities placing stress or little stress on the fracture area, the overall fragmentation, the bone density and Vitamin D levels, eating habits, etc. You want to do the contrast bathing as a deep flush. A CT scan would give us the best imaging at this point.
     I have many patients that the sesamoid does not look great on any imaging, but do fine, and as long as we can keep the pain between 0-2, and they are happy with activity levels, I just follow them.

The pain wasnt unbearable I just wanted the second opinion because I am 32 and work a pretty physical job (PT assistant in an inpatient setting) so on my feet many hours a day.  I also enjoy running and hiking. Those are things I wasn’t able to do the past year so I have substituted with using a stationary bike and weight lifting. I have been using a dancer pad and started wearing hokas which I love but the pain still lingered. I feel like I’m too young to just give up but I am really hesitant to get surgery for this. My podiatrist said if this doesn’t heal she would like to do a bone graft and use it to pack in between the non healing fracture. It seems like more trauma to my foot than I’d like to deal with. I know I should be more positive because maybe this can heal with NWB and bone stimulation but again I’m skeptical. I should also mention I started taking a vitamin supplement to help bone healing.

I’m sorry for the long email I just thought you should have all the info.
Dr. Blake's comment: Unfortunately, I have had no experience the results of bone grafting. If you find any articles, please send my way. I just want to know if you have surgery, they are just not experimenting with you. I am not a surgeon, so I have to leave final decisions to surgeons, but send me one or two images of the fracture from a CT scan and I will give you some thoughts. Have your Vitamin D level measured. Go 6 months on this course, although at some time you will have to switch from NWB to a weight bearing boot for 4 weeks and then back into your Hokas. The bone stimulation should be 9 months period. Hope this helps. Rich

Thank you in advance for even reading this and thank you for what you do!

1 comment:

  1. My son was pushed by a kid and fractured his right foot big toe sesamoid not sure which one as I did not know there were 2. That aside he is a competitive swimmer and we were thinking about surgery. He was on crutches with boot now just has boot. His right foot is is dominate foot and feels pain with on the starting block and pushing off the walls. We are following up with his surgeon on Wed. May I please have your feedback on specifically how many weeks/months of recovery time and pain after surgery? I do not want to end his swim season or possibly career – he will be starting university in the fall. Any information would be most appreciated! – Swim Mom


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.