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Saturday, November 14, 2020

Sesamoid Break with Pain Out of Control: Email Advice

Hello Dr. Blake-

Looking for an opinion and I have hit a wall I feel like. I have 4 year old twins in this past June they ran over my feet while riding in their power wheels (accidentally) causing my Sesamoid bone to break.

 I had xrays to confirm it (Drs were able to confirm it was a break by comparing previous xrays two years ago showing the bone was not broken). I was immediately put into an air boot and for the first two months followed with xrays each time showing no healing. I then was sent to an orthopedic who recommended foot orthotics however after going from the boot to the sneaker with orthotics the foot got worse and my tendon between the big toe and the toe next to it became irritated.

 I was then sent to a podiatrist who put me back in the boot and had me tape the big toe 24/7 and xrayed me each month through September, still no signs of healing. In September he gave my a cortisone injection which was horrendous but after two weeks it did calm the area down but that only last until about two weeks ago.

 I saw him at the end of October and he has me taping 24/7 the toe next to the big toe and staying in the boot fulltime other than to sleep. Now my entire foot is swollen, I have pain not only where the Sesamoid break is but now across my toes, top of my foot, and it wraps around my ankle to the achilles and back to the inside and underneath the arch of my foot. I have swelling and bruising in all of those areas and have also started to bruise just above my joint where the foot meets the leg (lower shin area).

 The pain in my ankle and achilles is almost unbearable in and out of the boot. My podiatrist has requested me to have an mri but hasn't scheduled it yet and I don't go back for xrays again until next week. Since June I have had it elevated every night and use ice packs. I can’t take any anti-inflammatory medications because I have an allergy to nsaids and ibuprofen which has made it difficult to control the swelling and pain. The podiatrist did try me on prednisone before the cortisone shot but it did not work and gave me arrhythmia so he discontinued that.

 I am a 35 year old Mom of 3 all under the age of 10. I am extremely frustrated but also worried that we are missing something. Does it normally take this long to heal and also can other ailments occur from the Sesamoid taking so long to heal? How concerned should I be regarding the new areas of extreme pain and swelling? I feel like my doctors down play it and I just don’t want to keep getting worse. Is there maybe some other diagnoses I should suggest being checked for now? 

Maybe someone not from my area like yourself may have other suggestions that I could inquire with my doctor about when I go back this month? I have included pictures. The first three photos were from Friday and the last one with painted toenails is from tonight. The swelling is all over the place and up and down consistently since June. I am not a diabetic, I am not severely obese (5”7 160lbs). My only medical history is allergies to medications, graves disease that I take thyroid medication for, and I had a hysterectomy after my twins 2 years ago and take estrogen every day as a replacement. Thank you in advance.

Dr. Blake's response: Thank you so very much for your email. Initially, you were just treating a broken sesamoid which is in some form of healing or non-healing, but that is not what you should really work on now. You have developed perhaps a nerve hypersensitivity from the chronic pain and prolonged immobilization. Go to the doctors, and say CRPS has been suggested as your pain is out of control. The treatment for this should be now, so I would forget the broken down until this is addressed. The mottled skin in the photos could be a sign of CRPS which stays for Complex Regional Pain Syndrome. You may need a sympathetic block in your back. I developed CRPS personally after a herniated disc in my back, and I was literally rushed to get the injection. You need to throw this word around until someone takes you seriously. Typically you may have to go to the ER to start the process, but any doctor who agrees with me can get you going. If it is not, great!! If it is, the sooner you get treatment the better. 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.