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Thursday, December 8, 2022

Sesamoid Injury: Email Advice

Dr. Blake -

     On October 24th I was doing a tempo run as part of my half marathon training when I noticed my left foot hurting (on top) I took a week off and thought it to heal but it still hurt. I went to get an x-ray which revealed a clear break in my sesamoid bone.

Dr. Blake's comment: The sesamoid fracture should give you only pain when it first presents under the big toe joint.  I am assuming the examination showed pain under the sesamoids. 

     They gave me a CAM boot and said wear for 6 weeks and scheduled an mri to confirm it. 3 weeks after I got the boot I had the mri which confirmed the break. They said they want me in s boot for 12 weeks.

Dr. Blake's comment: So far, the advice is sound. The boot should be worn with an EvenUp on the other side. If there is pain in the boot over 0-2, you have to wear off weight bearing padding to shift the weight lateral. Also, this is the time to cross train with stationary bike, swimming, etc (just no impact). Also, winter stress fractures always have me concerned about Vitamin D deficiencies, so please have it checked.  

     I am on week 6 and it seems to hurt worse than it did at first. I am an avid runner and exerciser and I feel like I am losing my mind. They mentioned most likely me having to have my sesamoid removed. I want to try anything to avoid this. I am current in a post op hard soled shoe and want to know if I am doing everything I can to heal in the next 8 weeks. ANy advise would be greatly appreciated. I can pay you and can send over my x ray if needed.


Dr. Blake's comment: Yes, you can send xrays and MRI to Dr.Richard Blake, 900 Hyde Street, San Francisco, California, 94109. Why are you not in a CAM walker now? Have they designed off weighting orthotic devices for you which can be worn in the boot? Boots can cut off the circulation, and sometimes patients wear too much (only need for walking). Is there alot of swelling, which can give you pain? Send a photo to the of the top and bottom of your foot. You can see if contrast bathing, usually very helpful, soothes the foot. Start with one minute hot and one minute cold water and rotate up to 20 minutes each evening. No surgery considerations until after you have had 9 months of Exogen bone stimulator for a non healing fracture. Typically repeat MRI at the 6 month interval, although 3-6 months are considered okay. I like to wait as long as I can, but sometimes we need to know sooner. Hope this helps. You have create that constant 0-2 pain level if you are going to predictably heal well. 

Patient answered:

Thank you so much!!! I can’t find anyone in my area that seems to be experienced with this break. They all say surgery most likely. The CAM boot hurt other areas of my foot and my opposite hip. It’s so heavy, I haven’t been fitted for orthotics as I’m not even sure where to start. I don’t really have much swelling and it looks a little bruised on the top of the ball of my big toe. I’ll send my records to you. I will also post this on your site.

Dr Blake's response: Try this local Podiatrist who is a member of our national sports academy, the AAPSM. 

David E. Linde, DPM205-445-0661One Independence Plz. #530BirminghamAL35209
Also, try bike shoes with embedded cleats instead of the boot to immobilize. 

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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.