First off thank you for your blog and website - I've learned so much from it. I would not know about contrast baths or a bone stimulator if it were not for your sesamoid fracture guide online. I emailed you in the past about an earlier stage of this injury - and your advice about not wanting to fall in the hole of my custom orthotic was super helpful. I've had less pain since switching out of it.
Dr. Blake's comment: I am trying hard this year to answer a few of the hundreds of patients who email me. I am sorry to all of you that I have failed to respond.
I am a previously very active 27 year old female - 6 months into a sesamoid fracture in my right foot. I am not a runner - but I power walked a lot, took yoga and barre classes, and weight lifted. Around mid september I also started developing pain in my left foot - from compensating trying to stay off the right with a knee scooter and iwalk crutch. I've had periods of upward trends, but can't seem to really get better.
Dr. Blake's comment: The patient shared her current MRIs with me and both feet in the area of the sesamoids under the big toe joint were healed, or almost there. Unfortunately, sesamoids remain sensitive enough to not feel healed. They seem to develop nerve hyper sensitivity and hold on to swelling. Both of these are painful. It is why it is so hard to make judgements without MRIs.
My best period was in oct/nov with altra vanish carbon 2s and gel 1/8" dancers pads directly on both feet. My doctor told me to start increasing activity, which I now think was too soon as my symptoms got worse. I also started to struggle with the dancers pads moving and not sticking no matter what I did, and putting more weight on my sesamoid with their shifting. I have them under my insoles now, but they don't feel quite as effective as when they were on my feet directly.
Dr. Blake's comment: You need almost twice the thickness of a dancer's pad if you are putting it on the insert, versus the foot. So many patients do both.
I'm getting quite frustrated as one doctor recommended surgery in September, another was helpful at first but then a few weeks ago recommended removing my left bunion, right bunion + right sesamoid. I recently starting seeing a new doctor who isn't at the surgery point yet - but has shared that he wonders if fixing my right bunion would help the broken sesamoid heal. My doctor initially told me that my left foot pain was sesamoiditis/metatarsalgia/
Dr. Blake's comment: The patient had a bipartite sesamoid on the right, which is healed to the point, that the break or separation of the junction of the two pieces, should be good to go on their own. At a certain point, and definitely after favoring and immobilizing the foot for 3 months, the bones start to weaken and that hurts. Nonweight bearing of a sesamoid injury over one month can be terrible,as the bones quickly begin to demineralize and get weaker and more painful. The left side sesamoid was never broken, and the bunion mal-alignment can be a reason for a slight amount of arthritic signs and symptoms are occuring.
I know this can take a while but the reduction in quality of life and loss of muscle is really getting to me. I haven't been able to walk my dog for six months, and have to get help with so much daily stuff. The more I sit to try and stay off of it just makes my hips worse.
Dr. Blake's comment: Motion is the Secret to life, and motion is lotion to our joints. You can definitely move, gradually over the next month add more and more walking. You do have to pay attention to pain. Is the pain during activity, but fine after (then it is okay to do as long as the pain is not worsening overall). If the pain is not felt until after, and pain is 3-5 on the pain scale, the activity is still fine. You have to reduce the level of activity and add spica taping, always with your dancer's pads, etc.
I have some pointed questions and am attaching pictures of my MRIs and the xrays I have (though noting the xrays I have are not the most recent ones). I can't seem to download the whole MRI and just took a screenshot - but if looking at all the images would be helpful I can share the login I have to view just my MRI results. A few views of the right looks like there's a crack on the right and another view doesn't show that.
Dr. Blake's comment: She let me see her images but sharing her health portal login and password.The right foot is bipartite, so the crack is not a true crack, and will never look better (only feel better).
1. Cortisone Injection in Right foot
Is this a bad idea for healing the fracture? My new doctor recommended trying it to decrease inflammation - currently scheduled for 1/17.
Dr. Blake's comment: Two types of cortisone, short acting (okay) and long acting with acetate crystals (a terrible idea).
2.CT scan in right foot?
At this point I've had 5 different sets of x-rays of my right foot, an mri of my right foot (2 weeks ago), two sets of x-rays of my left foot, and an mri of my left foot (back in early November). I have a CT scan of my right foot scheduled for 1/10. I'm wondering if this will really show anything different/is worth the extra radiation? I’ve had a couple doctors mention the possibility of a biparte sesamoid - but with no conclusive answer.
Dr. Blake's comment: Cancel CT
3. Footwear + Pads
Currently in these with a dancers pad under the sole on both shoes: https://www.altrarunning.com/
I also have hoka bondis that I love and are super cushy - but feel a lot of movement in so I've just been wearing at home with a dancers pad directly on the foot
Dr. Blake's comment: For walking, both this Altra and the Hokas are fine
4. Is using a recumbent bike safe for the fracture? Pilates with Glute bridges biasing the weight in my heels?
I had been swimming with a pull buoy for exercise and doing some kneeling and seated work out videos - but after doing so much upper body exercise I strained my right tricep a few weeks ago. Just got a recumbent bike - do you have any thoughts on whether this is safe for fracture healing?
Dr. Blake's comment: Recumbent bike is fine. Research Caroline Jordan's videos on exercises for sesamoid injuries.
I also have been doing some mat pilates - the glute bridges feel great on my hips, but I'm wondering if that kind of weight on the sesamoid would be detrimental?
Dr. Blake's comment: Weight at this point is fine, we have to get your body used to it, ice after for 10 minutes if you do anything to irritate. And, of course, that nightly contrast bathing is super.
5. Anything I'm missing?
Right now I'm icing both feet for 10 minutes 3x a day; doing a contrast bath with both feet for 20 mins, with 4 hot, 1 cold; exogen bone stimulator once every day; trying to stretch my calves with a foam triangle block + using a calf roller; applying voltaren gel every evening; and otherwise limiting painful activity such as standing and walking
Dr. Blake's comment: When you have been limiting, you then have to gradually reintroduce. I would only ice if you have aggravated. Keep track of what you do, and for how long it takes the pain to get between 0-2 again.
I'm wondering if there's anything I'm somehow missing that I could be doing to improve healing?
Dr. Blake's comment: Definitely have Vit D blood level checked and I would get a bone density test to make sure you are good in the overall bone health category.
Thank you for your time!
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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.