Total Pageviews



Friday, December 27, 2019

Sesamoid Injury: Surgery in a Few Days Scheduled

Hello Dr. Richard Blake,

     I stumbled across your blog and am hoping to get your opinion on some sesamoid issues I’ve been having over the past 12 months. Your input and advice would be greatly appreciated as it seems you are very well versed with these injuries. Here is my story

     I’m a 24-year-old male and I have a sesamoidectomy scheduled one week from today (at the time of this blog post). My issues first began in January 2019 after skateboarding on a concrete boardwalk for about an hour and the next day my left foot was very sore. Within about a week the big toe joint became very inflamed and I could hardly put any weight on the foot. I went in to get an x ray and suspected I may have fractured my sesamoid bone but the x ray came back negative only showing bone marrow edema in the MTP joint. I was already aware of these sesamoid bones because I fractured my right one when I was 17 and after over a year of failed treatments I ended up having my medial sesamoid bone removed in that foot. I’m relatively pain free in that foot now but I definitely can’t do the things I used to athletically speaking.

     I spent about a month wearing a boot on this new injury and was eventually able to transition to a running shoe with a steel plate in it about two months after it first flared up. I was later on given some plastic orthotics which restricted the motion of the MTP joint. Fast forward to August 2019 and I was still having pain and could not walk long distances and my gait was still altered. I ended up getting an MRI and the diagnosis was bone marrow edema within both partitions of medial bipartite sesamoid. They knew I had a bipartite sesamoid because they had x rays from years ago. I saw an orthopedic surgeon shortly after and he recommended surgery. He showed me the MRI and how there was a jagged edge on the medial sesamoid and fluid in the bone which apparently indicated degenerative changes. At that point I schedule surgery and decided I was going to try to attempt to transition out of orthotics and would cancel if my foot felt better by surgery time.

My foot has definitely improved but the pain is still there. I can walk alright but I am not living the very active lifestyle I desire. Some days are worse than others but there always seems to be at least some pain and redness in the injured foot. I avoid impact activities and I believe I am definitely walking with an altered gait to compensate for the pain. I feel like this is negatively affecting the health of the rest of my body including knee, hip, and low back.

My question is do you think I should just continue to wait this out and hope the pain in my foot eventually goes away? Or has it been so long that its unlikely to completely get better at this point? Is there anything else I should try before getting the surgery? I’ve diligently iced and avoided activities that cause pain over the past 12 months and I’m getting so emotionally drained dealing with this. At the same time I am so worried that I’m jumping to the surgery too soon when it there’s still a chance the foot could get better on its own. However, my surgeon doesn’t think that’s very likely at this point and is a proponent of the surgery.
Dr. Blake's comment: Thanks for the email. After 6 months of dealing with sesamoid fractures, the standard of care is to remove the sesamoid. But, as you said with the sesamoid removal in the past, you have had some permanent changes. There is no sign of bone fragmentation or sclerosis of avascular necrosis, so there is hope you can heal. I feel the sesamoids break by accident, as in your case of overloading against cement (where the cement won), but do not heal in young healing individuals like you when something is missed. That can be your biomechanics that put too much weight on the sesamoids. It can be Vit D deficiencies, which I am always dealing with in the winter months with my athletes. It can be that you have not been treating it correctly, so I will list the top things you need to do for the next 6 months. They are:

  1. Exogen Bone Stimulator twice daily
  2. Contrast Bathing for 5-7 days per week for a deep flush
  3. Vit D Blood Test and correct if low
  4. Biomechanical treatment to off weight the sesamoid 24/7
  5. Keeping the Pain levels between 0-2 (must stay here while being physically active)
  6. Avoid Cortisone shots and the use of NSAIDs
  7. If swelling persists, get PT
  8. Cross Train with cycling, swimming, and the elliptical flatfooted
  9. Massage painlessly twice daily for 2 minutes to desensitize.
  10. See a sports doctor who is not a surgeon for an opinion, or, without telling someone about this list find a doc who mentions at least 6 of the above.
  11. Go to the AAPSM to find a local sports podiatrist
Then get another MRI at the same location and see what the comparison. No healing, surgery is your best option. No regrets. Some healing, keep going for another 6 months. A strong sesamoid will help you for years and years be active, but with your history, I would always protect it. Good luck! Rich

I greatly appreciate your input.

Kind regards,

No comments:

Post a Comment

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.