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Sesamoid Fracture: What You Need to Know
Dr. Blake’s Patient Handout
Sesamoid fractures—small breaks in the tiny bones beneath the big toe joint—are stubborn injuries that often take months (or even up to 2 years) to fully heal. But with the right strategy, most patients recover well.
✅ Top 10 Initial Treatments
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Bone Stimulator (Exogen) – Use daily for 6–9 months to enhance healing.
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Boot or Stiff-Soled Shoe – Wear consistently for 3 months to keep pain at or below 0–2.
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Ice and Contrast Baths – Ice twice daily + nightly contrast baths (twice on days off) to reduce inflammation and swelling.
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Custom Orthotics – Designed during the first 3 months to offload pressure from the sesamoids.
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Dancer’s Pads – Learn to make and use these felt pads to relieve pressure (adhesive felt from Moore Medical works well).
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Spica Taping – Learn taping techniques for use after the boot phase.
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No Barefoot Walking – Always wear protective footwear, even at home.
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Stay Fit – Begin safe cardio, core, foot, and ankle exercises as early as possible.
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Nutrition Check – Ensure good intake of Vitamin D, Calcium, Magnesium, Zinc, and screen for bone density issues.
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Activity Modification – Gradually return to normal activities over 2–6 weeks after the boot; avoid increasing pain.
💡 Key Insights from Dr. Blake
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Most sesamoid fractures heal, though slowly—be patient.
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Imaging is crucial: MRIs or CT scans provide clarity, especially 5–6 months after baseline.
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Sometimes the problem isn’t a fracture—diagnostic accuracy matters.
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Bone health is key: Evaluate nutrition, vitamin D3, and bone density.
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Recovery follows 3 overlapping phases:
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Immobilization
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Re-Strengthening
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Return to Activity
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Avoid phase mismatches: don’t resume activity too soon.
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Your treatment team should plan for the return-to-activity phase from the start.
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Protected weightbearing (not non-weightbearing) is usually best—walking helps flush out swelling.
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Contrast baths are the gold standard for swelling reduction.
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X-rays alone are not reliable—advanced imaging is often needed.
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Joint mobility must be preserved: Start pain-free range of motion exercises early.
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Strengthen early: Even modified strengthening helps prevent long-term weakness.
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Setbacks are normal—don’t lose hope.
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If you’re dealing with a fracture, get a bone stimulator early (self-pay if necessary).
📺 Bonus Tools
Visit YouTube and search:
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“drblakeshealingsole Self Mobilization”
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“drblakeshealingsole foot and ankle strengthening playlist”
📌 Final Thought
Healing a sesamoid fracture takes time, consistency, and smart treatment choices. Stick with your plan, monitor your symptoms, and don’t hesitate to seek expert care if progress stalls.
Hi Dr. Blake. I am willing to give you $3,000 if you resolve my sesamoiditis without surgery. I am desperate. I'm 26, it's the tibial kind, it has gone on for 13 months, and there was never a fracture as far as I'm aware, just chronically inflamed. I'm an avid tennis player and I don't know what I'll do if I can't back to that (and normal life) soon...
ReplyDeleteHi Dr. Blake!! I felt sesamoid pain for the first time a day after you posted this, so you have perfect timing. My first podiatrist saw me the day after and just said to RICE it, but it got worse even just walking/hobbling around the house. August 4th I started complete immobilization with no walking at all and 3x/day 10minute ice baths. August 13th I saw a new podiatrist and got confirmed sesamoid fracture. Per your advice, I have a baseline MRI on the way, just requested an Exogen referral, and am starting contrast baths tomorrow. However, I’m a little lost about how to go about the immobilization phase. I was given a boot and dancer pads, but the custom orthotic won’t be here for another 3 weeks. I don’t know to what extent I should be walking and have been fully offloading it for 10days now. Some people say any walking at all puts pressure on the sesamoids and keeps them from healing, and some say it’s good to flush out inflammation. I’m scared of anything that could prolong the healing process, and have no idea if it’s even safe to walk in the boot without the custom orthotic. What timeline / progression would you suggest for starting to walk again or testing it out? Also, I was taking ibuprofen for the first 10 days then switched to voltaren, but seeing your post on NSAIDs and bone growth, I’ve stopped. Is this the right move? Thanks so much, any and all help appreciated.
ReplyDeleteSara, yes, please stay away from NSAIDs. The off weighting tends to hurt patients in the long run, but I understand its purpose. The real goal is figuring out how to maintain 0-2 pain levels. Weight bearing is important for bone strength and swelling reduction. You need to slow increase the foot pressure over the next 10 days as you go from no weight to full weight. Each day add a little more and eventually you should be totally off your crutches. You may want to request a PT referral to have an objective person help you. Weight bearing will not re-break your sesamoid! Never seen it, however too much weight bearing eliciting pain over 2 consistently can keep the pain cycle going. Make sure your Vit D is good also. Rich
ReplyDeleteHi Dr Blake, hope you're well. I am nearing six weeks PWB with a boot with a sesamoid stress reaction. Staying in 0-2 pain levels. I am wondering about how much to dorsiflex my big toe when I am NOT weight-bearing - for example, doing toe yoga (using my foot muscles) or manual mobilization (moving my big toe with my hands). I assume I shouldn't do anything that causes pain. But beyond that, should I avoid dorsiflexion even when non-weight-bearing? Just wondering about how to safely maintain ROM. Very much appreciated, thank you!
ReplyDeleteYou actually do not want the big toe joint to freeze up, so active range of motion that you can do with your muscle power is wonderful. Rich
DeleteHello Dr. Blake I have seen some comments online that promoting blood circulation to the area is very crucial for the injury to heal, i am currently in a moon boot and also 3 months into my injury but (June 25th i noticed swelling on the sides of my big toe but was only ever properly diagnosed on Aug 7th) I only started to immobalize my big toe on Aug 6th. For refrence i am 20 years old so my podiatrist assumed that i would have plenty of blood circulation to my foot and that cycling even with my heal is to risky but ive heard online for athletes that cycling via the heal has done wonders for them i was wondering if you woukd reccomend cycling as a form of exercise of course without the use of your sesamoids?
ReplyDeleteSincerely,
CD
yes, for sure, cycling with the heel and arch, as long as you off weight the sesamoids is perfect. Ice soak for 5 minutes afterwards to cool things back down. Rich
ReplyDelete