Sesamoid Injury: Email Advice

Hello!

I have been having sesamoid pain for over 1 year now. Originally, I injured the outer sesamoid bone on both feet while playing basketball. It was an overuse injury rather than a one instance injury.  Over the past year or so I haven’t played basketball, but the bones seem to be healing extremely slowly. I never wore a walking boot, but about 7 months ago I did have custom orthotics made with sesamoid offload. My doctor never came out and said whether I have a fracture or not.. would you be able to tell from the attached xrays? Also, is it still possible to heal via walking boot, etc.

Thanks!!

Both xrays show irregularities of the tibial sesamoids, but to develop pain at the same time a irritated bipartite sesamoid is the most likely. If you look really close, there are many pieces of sesamoid there so a multi-partite sesamoid is most likely versus fracture. 

Dr. Blake's comment: 

You have to create the 0-2 pain level for the next 6 months to allow for healing. Yes, they look like fractures or just multi-partite sesamoids, but only an MRI would tell for sure. In fashioning a 0-2 pain level over a prolonged time, I usually have my patients ice 1-2 times daily, contrast bathes 3-5 times weekly, and alternate from bike shoes with embedded cleats, Hoka One One rocker athletic shoes, and anklizer removable boot. The patient typically can feel when they can use each (but the boot should be on 4 hours minimum of each day. I also get a bone stimulator to use when insurance allows me to speed up the process, make sure that their Vit D levels are fine, and eat healthy. Injuring both makes me wonder about your biomechanics (do you have a high arch?) or bone health issues (which your PCP may want to investigate). You take it one month at a time. Also very important to learn spica taping and cluffy wedges, and always feel that the dancer's padding is the right amount (it can vary by shoe gear). When patients have soft sandals for home, and can walk flatfooted (no bending the toe), they can quickly get to shuffling around the house. Just no barefoot. I hope this helps. Rich 

And the Patient Response:

Doc, thank you so much for your reply!  

I'm suspicious that I injured both due to unfortunate circumstances (no bone health issues in the past and I have fairly neutral arches).. I weighed about 310 lbs (height: 6,1) when I initially felt "injured", so I'm wondering if it was due to being overweight and pushing my feet too hard for too long.. I was playing basketball 3-4 times/week so I was definitely pushing my sesamoids at that point.  I'm feeling much better on a day-to-day basis now (pain level ranges from 0-3 most of the time).  I am currently wearing tennis shoes with a full length metal plate insert under my custom orthotic which includes sesamoid offload.   This combination seems to be working pretty well.  I'm able to walk 1-2 miles/day with minimal discomfort (daily exercise).  From your advice, I may decide to take it a little more easy for a few months and see how I progress.  I've always been pretty active and even kicked field goals for the better part of my life without any sesamoid pain.  It wasn't until I reached 300+ lbs that I started having problems.  Weight loss is in full affect, so hopefully that helps as well :)

Thanks again for your advice!