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Tuesday, January 19, 2021

Sesamoid Fracture: Email Advice

Hello, Dr. Blake! 

I was diagnosed with a sesamoid fracture on Nov. 18th, 2020. Throughout the two months, I have been wearing a walking boot and supplementing calcium, vitamin D, and taking a multivitamin. After two x-rays over the last two months, my doctor told me that there has been minimal healing. 
Dr. Blake's comment: Xray show only solid bone, and most of the initial fracture healing is with new skeletally immature bone that shows poorly on x-ray. Therefore, most agree that x-rays lag 1-2 months behind actual healing. Said in English, if an x-ray shows good healing in March, the bone was probably healed enough in February and probably January. So, minimal healing noted on x-ray is not really the whole story. MRIs are better for fracture identification, when x-rays are inconclusive, but you have to wait 6 months to the validation of some healing. I do x-ray for that information, and I get an MRI for that information, and I treat the sesamoid fracture and the patient based on getting them to be at 0-2 pain level as quickly as possible and then maintaining them at that level for 3 months. 

At my last visit, Jan. 14th, 2021, he felt around my foot and I didn't feel any pain (although he was very gentle). He instructed me to wear regular shoes, and ditch the walking boot so long as there is no pain. He told me to try exercising, but avoid inclines and do not run. If I continue with no pain, then he said it is okay if I go about my life with the bone still fractured. If I experience pain, he plans to take an MRI of my foot on Feb. 10th to see if he needs to remove the sesamoid bone. 
Dr. Blake's comment: I hope you just mis-understood. Continue to wear the boot until 2/18, and if you have taken it off before you read this, add a few more weeks so you can say you wore the boot for 3 months. It takes a year or more to know whether you need surgery. I am assuming that the pain in the 0-2 range while you are in the boot. Between now, and the time you are getting out of the boot, you need to have protective orthotics with dancer's pads to off weight the sesamoids, typically Hoka One One shoes are used due to their rocker. The transition from full time boot to full time out of the boot may take 2-6 weeks on average since pain level has to be your guide. 

It was May 2019 when I originally injured the bone. I noticed the pain when I had finished my third day in a row of working in the same pair of shoes (Chacos, not yet fully broken in). After a few days, the pain subsided for the most part. After several months of sporadic pain, I got an x-ray at a walk-in clinic, and they told me that nothing was wrong. After training for and running a marathon, I finally went to a foot doctor who then found the fracture using x-rays. Throughout the year or so of pain, it was never as painful as the first 24 hours of when it was originally injured. 
Dr. Blake's comment: This is great. Hopefully, the injury, while frustrating will not prove very serious when you get the MRI. You could have a normal bone that lies in multiple pieces that was fractured slightly last May, but now needs a little help to finish the healing. If there is swelling in the tissues, or seen on MRI, then contrast bathing to flush the bone and create better circulation should be done close to every night. 

To be honest, I am afraid of taking my doctor's advice of potentially living the rest of my life with the fracture in my foot. I read on your blog that it takes 2 years in some cases to heal the sesamoid bone, and it is rare that the bone does not heal. I do not want the bone to be removed; I fear the side effects of surgery may be worse than simply living with the fractured foot. Dr. Blake's comment: Yes, you will not live with a broken down. You are too smart for that. You may need an Exogen bone stimulator to help, along with spica taping, cluffy wedges, great off loading orthotics, Dr. Jills Gel Dancer's Padding, etc. 

My purpose in writing to you is to get a second opinion on my doctor's plan for my sesamoid fracture. In the meantime, I plan to wear stiff shoes and use dancer pads to keep the weight off my sesamoids in both feet. I use heat and ice on my foot as well when the swelling feels worse. 

Thank you so much for being the doctor we all need in our lives. I appreciate that you take the time to listen to people and give thorough advice. 

I hope this email finds you well. Dr. Blake's Comment: You are welcome, and good luck 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.