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Friday, November 22, 2019

Sesamoid Injury: Cortisone Shot or Not?

Hi Doctor Blake,

I stumbled upon your blog after lots of sesamoid research! And now I am asking for your help with my recovery... 

Long story short I’ve been off from dancing (just wearing special sneakers with dancer’s pads) for 7 weeks now for a micro fracture of my sesamoid. I just received an MRI with these results below (apologies if the translation from another language is weird):

Presence of bone edema of the entire medial sesamoid, with low T1 hypersignal T2 signal.  No fracture-separation of the bone, no sign of necrosis, and in particular no deformation of the bone surface.  Reactive joint effusion of the MTP 1. Light hallux valgus (confirm on radiography under load).  No sign of sesamoido-metatarsal osteoarthritis.  A little edema of hyperfunction of the plantar tissue in contact with the medial sesamoide.  No anomaly of the stabilizer of the sesamoid.  No abnormality of the hallux tendons.  Moreover no anomaly of other MTP and inter-capito-metatarsal spaces.  CONCLUSION: Appearance confirming medial sesamoiditis, without fracture or underlying necrosis.  Light hallux valgus (confirm on x-ray in charge)

I am seeing two different specialists in my country but now I have run into the problem of opposing medical solutions and I am not sure which to go with. 

One doctor recommends a cortisone injection and the other recommends oral anti-inflammatory medication. The doctor who recommended the oral medication told me that the cortisone injection is very dangerous for a sesamoid as it damages the foot’s natural padding, therefore exposing the sesamoid to further damage... 

The doctor who recommended the injection told me that the oral medication will not do anything to help the sesamoid and that all stories about sesamoid’s being made worse by injections are mainly myths and cannot be proven.

I am emailing to ask your advice on this debate? I am hesitant to get the injection because of all the mixed reviews online but it is a more “immediate” and localized option which is tempting. Do you have any feedback or success stories of oral medication? Or any thoughts on cortisone’s long term risks?

Any feedback you could offer would be greatly appreciated! 

My apologies for such a dense email, but your knowledge would be so helpful for me!

I thank you in advance for taking the time to read this email and I hope to hear from you soon.

Sincerely,

Here on this MRI image healthy bone is dark. The light tibial sesamoid indicates a healing response from the body. Hard to tell stress fracture (can not see) from bone bruise in these cases


Dr. Blake's comment: 

 I must side with the oral medications, which can not be taken before you dance (only after). Your MRI shows that the sesamoid has been slightly injured. Cortisone will mask pain for up to 3 days (short acting cortisone and not dangerous) to 9 months (long acting cortisone). Your dance career can not risk masking pain where the sesamoid injury worsens. You can ice twice daily and do contrast bathing every evening. You must float the sesamoid with Dr. Jill's dancer's pads of either one eighth or one fourth inch (3 to 6 millimeters). These can be bought on line and worn even walking around barefoot to protect the sesamoid. I have my patients get 2 lefts (both sizes) and 2 rights (both sizes) since the adhesive is on one side and at times you are wearing it on your foot, and at times you are putting it over or under inserts in shoes. Whatever you put on your injured foot, should be on the other foot for balance. I hope this helps. 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.