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Wednesday, January 27, 2021

Sesamoid Fracture in a Dancer: Email Advice

Hello Dr. Blake,

I am a 40 year-old dancer, though not professionally.  When I'm feeling my best, I dance approximately 1 - 1.5 hours per day 3 days per week, take 5 classes one day per week (tap and jazz), and one class on the fifth day of the week (hip hop), giving me two rest days.  
Dr. Blake’s comment: Probably too much at 40, but everyone is so different. Just think about your recovery time. With 5 days of weight bearing activities, definitely the 2 days should not be in a row (like Saturday and Sunday). 
I have injured my left foot three times now.  The first time, when I fell coming out of a turn, there was no reason diagnosis, but after the second injury I recognized it as a turf toe injury.  The second time (aggravated by lots of barefoot jumps and jump turns on hardwood) was diagnosed as metatarsalgia, rule out turf toe, and I did at least 9 months of physical therapy.  I had both a podiatrist and an orthopedist look at my imagining (x-ray and MRI, from what I remember) and neither saw any fractures or anything indicating any significant injury from either the first or second injury.
Dr. Blake’s comment: Accidents happen! Do you think you had fully recovered from these injuries before the latest one? Were you completely pain free and full activity after the second injury? 

Come to October 2020.  During the second half of a 10+ mile hike, on the last day of what became 25+ miles of hiking in Yosemite, I suddenly felt like I was stepping on a bruise.  I recognized the pain as being in the same area.  My doctor recommended conservative management, which I did.  Pain had not improved after one month and so I was seen in urgent care, they did x-rays that the radiologist said showed no abnormalities, and they gave me a post-op shoe to wear and said I was okay to be wearing my work boots.
Dr. Blake’s comment: Sudden pain like this, without a fall, in an overuse situation is a stress fracture until proven otherwise. 

I just saw a podiatrist at the beginning of January 2021.  He told me my lateral sesamoid is fractured and that he thinks it's been there since the first injury.  He did not listen to what I tried to tell him about what happened during the previous treatment.  His only treatment recommendation was to tell me to stop dancing.  Not for a discrete period, but as a blanket statement.  
Dr. Blake’s comment: I hope you can find a real sports podiatrist!!! Terrible advice! Check out the AAPSM website for members near you. 
When I tried to explain the importance of dance, he told me to get dancer's pads and then I could dance again.  He said that I will need to have surgery at some point in the future and told me that he would do a CT to see the level of separation.  He declined to do any additional imaging at that time and told me to keep him updated and that the referral will be active for 3 years.  He didn't want to see anything I've been doing on the meantime, didn't listen to the time I have taken off from dance already, nothing.
Dr. Blake’s comment: The CT is a good idea since you will have more information, although I would like an MRI first. 

I'm trying to figure out the best way forward and have already asked my doctor for a referral for a second opinion, but seeing as most people seem to think this is just some silly hobby, instead of understanding that I'm a hobby athlete and artist in one, it would be very helpful to have some idea what to look for going forward.  I just want to give myself the best possible chance to heal.  These injuries have been very frustrating and it's hard to believe that the only option is to do nothing until I need surgery.  I'm sorry this is so long.  I'm just frustrated and trying to figure out some options so that I can advocate for myself.  I appreciate your time and any assistance you can provide.
Dr Blake’s comment: I know you wanted to tell me your complete story, but try to start with October in a new email. Get an MRI (which you will probably repeat in 6 months) and go into a removable boot for now. You have to get the pain to 0-2 for the next 6 months. You should be icing and contrast bathing each day, and read alittle in my blog on the conservative treatments for sesamoid fractures. Please also get a Vit D level and probably bone density to make sure your bones are healthy.  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.