Sesamoid Injury in a Young Athlete: Email Advice

Dear Dr. Blake,

Thank you for your many videos and resources!

My son suffered a tibial sesamoid stress fracture on 9/27 and was initially on crutches for two weeks and has since been in a boot. He has a bipartate tibial sesamoid that mri revealed is in fragments and suspected AVN. We had a consult with his doctor on Tuesday and he recommended tibial sesmoidectomy. My son is still suffering from intermittent swelling/discomfort. I have him taking vitamin D with K, Calcium/Magnesium and naproxen. He has been icing and elevating, but at time overexerts his foot (his football season was cut short and now he’s sitting the bench for basketball). He is ready to feel better and wants to have surgery.

In your opinion, with the fragments, AVN and continued swelling/pain, should we proceed with the surgery? We were informed this could be chronic and it’s better just to have it removed now while he’s young and not in high school sports yet. 

Dr. Blake's comment: Thanks for the email and MRI report. I am never convinced that there can be AVN within the first 2 months of an injury. Your son developed a terrible injury with bone swelling in 3 separate areas. It would be so hard to recommend surgery on the tibial sesamoid when there are other areas that could be the primary cause of his problem. I am happy to look at the MRI if you want to send it. I think a second MRI really should be done 6 months after the first to see what is changing. No fracture is seen, so there is no reason to believe he can not heal just fine. An injury to a spot you walk on is always going to take the longest to rehabilitate. If the doctor is worried about bone healing, besides the wonderful attention paid to bone health, we need to get the Exogen bone stimulator and contrast bathing daily. I was in high school, and also missed a year with an injury. It was no fun, many tears, but I played college sports. If he loves sports, he will recover. Rich