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Friday, March 1, 2019

Sesamoiditis turning into Fracture: Email advice

Good evening Dr. Blake,

I am currently a student at a university. I suffered sesamoiditis in February of 2018. I visited the doctor and they took an MRI and Xray, and he said it was sesamoiditis. They gave a steel toe plate to insert in my shoe so I don't bend my toe too much and it did help for a little bit. A couple of months went by and I got used to the pain.
Dr. Blake's comment: I hope you understand that we must get the pain to 0-2, not just be helped, or you will not heal potentially. This is especially true with sesamoids that are slow healers in the first place.

I did try to ice as much as I can and the pain went away. I am a pretty active person, and just couldn't sit out during the summer while I trained. I didn't think much of the injury since it was a busy summer for me and didn't know that it is that big of an injury. I trained and ran with it and played basketball with it all of 2018. I adjusted my gait so I don't put pressure on it and that lead to other problems such as calf tightness and knee pain and hip pain.
Dr. Blake's comment: Thanks for being honest. I know we all try to just live with it with the eternal hope that it will eventually get better. At your age, I would have been doing the same thing, so no guilt allowed.

I stopped playing around a couple of months ago since I knew it wasn't really healing so I didn't want to risk it (Which I already did by running on it that whole summer.) I visited the doctor on 1/30/2019 and he took an X-ray where it was found that I completely broke it. The doctor said I have to get a procedure to take out the bone ASAP and referred me to a surgeon. I talked to the surgeon and he basically just told me about the recovery time and things of such and I told him that I read some people never return to 100% and he agreed and told me to just sleep on the option of surgery. He also said it has no chance of healing since there is no blood supply to this area. It doesn't look like it is a huge break, but is there a chance of it healing without surgery and could it union? I attached the X-ray picture to this email. I came across your blog because I was desperate and it has been so helpful. Please get back to me. 

Thank you so much

Even though this is alittle blurry one can see the obvious crack with jagged edges

Dr. Blake's comment: Okay, you got yourself in a bind. Please understand that there is no gap between the fragments, so the bone contact is good for healing. Yes, these heal slowly so the rest of this year will be dealing with your sesamoid in one way or the other. I am sorry when some of my patients need surgery after a long battle, but since the majority heal fine, the battle is always worth it. Plus, even if you need surgery, you will have the orthotics and dancer's padding that will protect the other sesamoid in high impact sports your whole life.
     So, you have to create the 0-2 pain level, get a bone stimulator, start doing daily contrast bathing for swelling reduction which improves circulation, get a Vit D test to make sure you are fine there to heal a fracture, eat healing, cross train with biking, swimming, flat footed eliptical, get Dr. Jill's dancer's padding at 1/8th inch and 1/4 inch for various shoes, get good custom orthotics to take pressure off the sesamoid, and learn spica taping and cluffy wedges and see if important for you. Some of my patients love some of the Hoka One One shoes, but that depends if the roll is in the right place. Zero drop shoes are better in general than traditional shoes. I hope this points you in the right direction. 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.