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Tuesday, November 1, 2022

Sesamoid Fractures General Rules


Sesamoid Fractures:

 

By Richard L Blake, DPM

 


The top 10 initial treatments for sesamoid fractures are:

 

  1. Exogen (ultrasound based) bone stimulator for 6 to 9 months
  2. Removable boot for 3 months to create a consistent pain free (0-2 pain level) healing environment with EvenUp over other shoe for balancing. This can be substituted by a bike shoe with embedded cleats for both feet.
  3. Ice pack twice daily and contrast baths each evening for anti-inflammatory and deep bone flushing. Do the contrast baths daily and twice on non-work days.
  4. During the initial 3 months of immobilization, have orthotic devices developed that off weight the sesamoids.
  5. Learn how to use 1/8th inch adhesive felt to make dancer’s pads for the boot and for post-boot action (patients also love the Dr. Jill's Gel Dancer's Pads that stick to the foot or shoe)
  6. Learn how to spica tape for post boot action
  7. When you are not wearing the boot, avoid barefoot (house slippers like Oofos protect and cushion well).
  8. Do cardio, core and foot and ankle strengthening the minute you hurt the bone, and on a daily basis. Keep Strong and Keep Fit!!
  9. Since we are dealing with bone metabolism, make sure your calcium and Vit D intake is good, and get counseling if you think that there might be a bone density issue.
  10. Use strict activity modification principles to keep the pain levels between 0-2 as you go from boot to regular shoes. The weaning out of the boot/bike shoe period can take anywhere from 2 to 6 weeks and no added soreness is allowed.

 In my Book Secrets to Keep Moving, I review the 20 top general rules for sesamoids.

https://store.bookbaby.com/book/secrets-to-keep-moving-a-guide-from-a-podiatrist


  1. They rarely do not heal.
  2. Even with normal healing, they can take up to 2 years so patience is a virtue here (some fast and some slow, and all patients want the fast ones).
  3. Healing, and feeling better, is based on many factors that are unknown when the patient first presents.
  4. MRIs and CT Scans are common imaging techniques that can really elucidate the problem, and sometimes change the direction of the treatment.
  5. Follow up MRIs, when needed to check healing, are often done between 5-6 months after the first baseline MRI. Always look at the first MRI as probably just your initial baseline MRI.


6.            The MRI can show initially that you are not dealing at all with a sesamoid fracture, but something else, and prevent treating the wrong diagnosis 

7.            Since we are dealing with bone, we must look at diet, Vitamin D3 levels, calcium/zinc/magnesium, and bone density.



8.            Treatment of sesamoid injuries flows through 3 phases that are normally overlapping--Immobilization, Re-strengthening, and Return to Activity.

9.            When the patient is in the Immobilization phase, the treatment visits should be thinking about (and acting on) the Return to Activity Phase with visits dedicated to shoes, orthotics, strengthening, and cardio.

10.         Often times treatment mistakes involve having the patient in the wrong phase (like return to activity when they should be in the Immobilization phase).

11.         One of the crucial aspects of treatment, that can be hard to design, is protected weight bearing inserts and shoes.

12.         As treatment starts, the patient is placed in an environment (be it cast, shoes, orthotics, boot, etc.) that maintains 0-2 pain level.

13.         The initial goal is to create this pain free environment for 3 months by whatever means it takes.

14.         Non weight bearing (via crutches or Roll aBouts) always increases swelling (which can be a big source of pain), so some protected weight bearing is crucial. Every step pushes fluid out of your foot.

15.         The best way for reduction of bone swelling is contrast bathing. Typically, icing twice daily and contrast bathing each evening is needed.

16.         If you are basing treatment on x-rays alone, you may be way off base.

17.         Do not let the joint freeze up (frozen toe syndrome) with routine pain free range of motion or mobilization techniques. Go to YouTube and type drblakeshealingsole Self Mobilization.

18.         Start strengthening the minute you get injured, or at least after you read this, even if it takes some modification for pain. Go to YouTube and type drblakeshealingsole foot and ankle strengthening playlist. Keep the joint/foot flexible and strong. No exercise should hurt however.

19.         Patients with sesamoid injuries are prone for setbacks so do not get discouraged.

20.         If you have a sesamoid fracture, one of the hardest fractures in the foot to heal, get a bone stimulator and begin using. Some insurance companies require 3 months wait to document delayed healing, some not. Self pay for Exogen Bone Stimulator is an option

 

1 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.