tag:blogger.com,1999:blog-673715911736059911.post3411968067019905294..comments2024-03-01T17:52:55.066-08:00Comments on Foot and Ankle Problems By Dr. Richard Blake: Sesamoid Fractures: Advice when not healing wellUnknownnoreply@blogger.comBlogger97125tag:blogger.com,1999:blog-673715911736059911.post-59262562162215081522020-03-25T09:40:00.535-07:002020-03-25T09:40:00.535-07:00Hello, I have currently been dealing with a fractu...Hello, I have currently been dealing with a fracture sesamoid bone since May of 2019. I have tried all treatments; walking boot for 6 weeks, custom orthotics to off-load the sesamoid, laser therapy, taping, bone simulator for almost 8 months now, and anti-inflammatory medicines. Nothing seems to be healing this fracture an I am getting very impatient and depressed with the whole situation as I am a very active person. It also seems to be messing up the mechanics of the rest of my body and my gait. My foot doctor wants to discuss surgery but I am very anxious and nervous about it after all of my research. My chiropractor specializes in PRP and Stem Cell Therapy. She wants to try it and see if it starts to heal this fracture. What are your thoughts on this treatment and have you seen patients where it works on? <br /><br />I just don't know how much longer I can take of this before the rest of my body falls apart although I will do anything to prevent surgery. Please let me know your thoughts.<br /><br />Also to the dancer from Milwaukee, if you see this I also live in Milwaukee. Did your sesamoid bone heal and do you recommend a good podiatrist/physical therapist in the area that treats sesamoid fractures? Thank you. Any help is appreciated! Shirahttps://www.blogger.com/profile/01807744509489917150noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-4823397616824664102020-01-27T22:10:15.317-08:002020-01-27T22:10:15.317-08:00Greetings from Ohio! I'm bored to death at wor...Greetings from Ohio! I'm bored to death at work so I decided to browse your website on my iphone during lunch break. I love the information you provide here and can't wait to take a look when I get home. I'm amazed at how quick your blog loaded on my mobile .. I'm not even using WIFI, just 3G .. Anyways, great site! <a href="https://www.stindia.com/copper-pipe-distributor-supplier.html" rel="nofollow">Copper Pipe</a>ruuk thomashttps://www.blogger.com/profile/05133583249060930773noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-28781004019081989182019-12-12T03:19:01.159-08:002019-12-12T03:19:01.159-08:00Positive site, where did u come up with the inform...Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. <a href="https://www.postdicom.com/" rel="nofollow">free mri viewer</a>Sandra Jessyhttps://www.blogger.com/profile/03477637892416078971noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-82351303224749457002019-11-02T05:28:58.538-07:002019-11-02T05:28:58.538-07:00Thanks for shared that blog with us. If anyone her...Thanks for shared that blog with us. If anyone here searching <a href="https://www.zioncarepharmacy.com/product/buy-vicodin/" rel="nofollow"><b>Buy Vicodin Online</b></a> then visit Zion Care Pharmacy.Zion Care Pharmacyhttps://www.blogger.com/profile/06612681477237707103noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-6178210088425341392019-07-16T06:15:32.279-07:002019-07-16T06:15:32.279-07:00Wow, excellent post. I'd like to draft like th...Wow, excellent post. I'd like to draft like this too - taking time and extremely hard work to make a great article. Visit <a href="https://veintreatmenttx.com/" rel="nofollow"><b>Vein Treatment Texas</b></a>. This post has inspired me to write some posts that I am going to write soon.William Ringhttps://www.blogger.com/profile/01679600930035008422noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-22743965671827649662019-01-10T20:31:57.999-08:002019-01-10T20:31:57.999-08:00An Exogen ultrasonic bone stimulator has been made...An Exogen ultrasonic bone stimulator has been made available to me by a friend. At this point (14 months after the fracture) is there any reason I should not try using it?Anonymoushttps://www.blogger.com/profile/03900187503760110731noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-22825863523330589852018-10-31T16:42:36.391-07:002018-10-31T16:42:36.391-07:00Dr Blake,
Thank you for your very informative blo...Dr Blake,<br /><br />Thank you for your very informative blog. It has more information about sesamoid fractures than most other sources combined. <br /><br />I'm 56 years old and have always been very active outdoors hiking and biking, although I've never been a runner. 12 months ago I felt a pop while squatting during some home repairs. The immediate discomfort was not great and I quickly forgot about it and learned to favor that foot slightly and not squat, thinking it would work itself out. As the weeks and months progressed, so did the discomfort. I never had any discoloration, obvious swelling or point tenderness. Range of motion is good.<br /><br />6 months after the injury I finally got an x-ray with diagnosis of fractured lateral sesamoid. The podiatrist said the pieces had moved too far apart to knit back together and gave me a steroid injection to help calm down the tendon. We also put a cut-out dancer's pad under my insoles to relieve pressure around the sesamoids. I started an ice massage 3-5 times/day. The plan has been to let things calm down, then make custom orthotics to replace the dancer's pad. Surgical removal was mentioned as a possibility if things didn't improve.<br /><br />By 9 months it was feeling much better and I was able to routinely hike 4-8 miles again, with pain levels in the 0-2 range. I stopped icing. Then I got a new pair of cycling shoes and did ONE RIDE without the relief pad. The next day I noticed slight discomfort had come back and it continued to get worse over the next two weeks. I resumed icing. A new x-ray at 10 months showed the sesamoid remains non-union and I got another steroid injection. Like the first injection, it took about 2 weeks before I sensed improvement. <br /><br />It's now been 12 months since the injury and I'm again feeling like there's hope of a good long-term outcome. But information here has me wondering. My questions are:<br /><br />1) Is the steroid injection simply masking symptoms?<br /><br />2) At this point, is there any hope that the sesamoid pieces will heal back together? If not, can I have an active lifestyle (backpacking, mountain biking) with a fractured sesamoid?<br /><br />3) How concerned should I be about degradation of cartilage on the metatarsal head caused by the rough, fractured edges of the sesamoid?<br /><br />4) What symptoms should I be alert for that would indicate avascular necrosis? Is AVN still a risk >1 year after injury?<br /><br />I'm emailing x-rays, in case they help if you have a chance to answer.Anonymoushttps://www.blogger.com/profile/03900187503760110731noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-22799861568987830122017-11-17T06:12:59.511-08:002017-11-17T06:12:59.511-08:00Hello Dr. Blake,
Can you do a post about bone gra...Hello Dr. Blake,<br /><br />Can you do a post about bone graft surgery on sesamoids? There seems to be very minimal data on this online.Anonymoushttps://www.blogger.com/profile/13191661107196992438noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-77311997563087947132017-08-15T17:26:06.065-07:002017-08-15T17:26:06.065-07:00Hi Dr. Blake,
Thank you so much for sharing your w...Hi Dr. Blake,<br />Thank you so much for sharing your wealth of knowledge regarding sesamoid injuries. I think I broke the inner piece of the right foot, big toe sesamoid two years ago. It was misdiagnosed & further use & abuse shattered one of the halves into 3 or 4 pieces. 1 month in a boot (same doctor who called it a bone spur) and now 2 months nwb with a new doctor and my foot is healing. Question: because the sesamoid was broken in 2015, will it remain in a non-union state? What are the ramifications of a non-union?<br />Sincerely,<br />Melissa Benford Melissahttps://www.blogger.com/profile/18283278618689832958noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-12293180399044090582017-07-12T12:42:14.711-07:002017-07-12T12:42:14.711-07:00My son has been diagnosed with sisemoiditis .He is...My son has been diagnosed with sisemoiditis .He is taking zerodol sp twice for two days but not geting any relief from pain and swelling. Mri scan has revealed mild effusion around the joint.The injury has been over two weeks while walking .He has been in constant pain ...throbbing pain since .He cannot walk normally nor can he tolerate ice .When and how will the pain go away.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-18752804461253163922017-06-14T14:55:49.796-07:002017-06-14T14:55:49.796-07:00Dr Blake
My son was diagnosed with a fractured bip...Dr Blake<br />My son was diagnosed with a fractured bipartite medial sesamoid after hyperflexing his foot in a soccer impact. <br /><br />He was in a boot for 4.5 weeks and recently moved to tennis shoes with custom orthotics to offload the area. <br /><br />It is difficult to find information on his situation because his two doctors do not expect these bipartite segments to ever reunite. The damage must be to the cartilage in between. <br /><br />I am worried that I am doing what is best for him. Do you have any advice? Worried momhttps://www.blogger.com/profile/11769847700582194914noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-27783203934103972742016-12-10T15:18:09.309-08:002016-12-10T15:18:09.309-08:00If you still need this email me at drblakeshealing...If you still need this email me at drblakeshealingsole@gmail.com. Rich<br />Sorry this comment was buried.Dr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-6250696666349119152016-12-10T15:17:53.376-08:002016-12-10T15:17:53.376-08:00If you still need this email me at drblakeshealing...If you still need this email me at drblakeshealingsole@gmail.com. Rich<br />Sorry this comment was buried.Dr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-49092219204568630712016-12-02T18:48:39.888-08:002016-12-02T18:48:39.888-08:00Brian, I am so sorry for your problem. You want to...Brian, I am so sorry for your problem. You want to save that remaining, even though broken, sesamoid. For me, 3 months in a removable boot, with daily contrast bathing for re-vascularization, 9 monthes of bone stimulation, definitely getting your bone density and Vit D3 levels checked. The boot need to be pain free with a short time, so placing off weight bearing dancer's pads may be needed. Experiment in 2 months with Hoka One One shoes, but all see a good podiatrist to make orthotics to off weight the area. I hope this helps you some. RichDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-52103185178301093632016-11-29T18:25:45.262-08:002016-11-29T18:25:45.262-08:00Hello. Thanks for making this page. I really nee...Hello. Thanks for making this page. I really need your opinion on my situation.<br /><br />Current situation: 4 months post-op left fibular seasmoidectomy. Today diagnosed with left lateral sesamoid fracture in remaining sesasmoid. <br /><br />I am devastated. I got a second opinion on my scans from an orthopedic surgeon today after leaving the podiatrist. He told me to use an immobilization boot for 6 weeks. <br /><br />The sesamoid quite literally shattered sometime in the last month. I have no idea how or when. <br /><br />The doc also suggested I see my PCP to get a bone density scan. The orthopedic surgeon suggested that his gut tells him I have had undiagnosed avascular necrosis.<br /><br />My question for you, do you think it was a bad idea to get a sesamoidectomy if I had AVN? What sort of outcome might I have if 6 weeks in a boot does not help? I am really having a hard time finding solid answers. We are looking to start a family and I am dreading how I can support the family with such a bad foot....<br /><br />Thank you,<br /><br />Brian Bain<br />Anonymoushttps://www.blogger.com/profile/07033817926801840507noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-3411158868826864492016-10-23T16:56:53.077-07:002016-10-23T16:56:53.077-07:00Hi Dr. Blake, your blog has been very helpful. Abo...Hi Dr. Blake, your blog has been very helpful. About 2 months ago I felt a pain in the ball of my foot. After continued pain I decided to get an xray; it appears to be have a space between the tibial sesamoid. If it's not too much trouble may I email you my xray and get a second opinion on the sesamoid. It appears to be either fractured or bipartite. The family practitioner I saw seemed to think it was fractured and healing/calcifying; but from looking at plenty of pictures online it might be bipartite. If possible is there an email I can reach you at? Can't seem to find one on this blog. Thank you - Ethan<br />Ethan Evanshttps://www.blogger.com/profile/06940926168619026048noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-7299040036188336302016-08-22T14:15:57.847-07:002016-08-22T14:15:57.847-07:00Dear Dr. Blake,
First thank you so much for your...Dear Dr. Blake, <br /><br />First thank you so much for your blog and readiness to respond to questions. I first noticed a small clicking noise, like cracking your knuckles, in my right sesamoid bone 16 months ago. I ignored it for four months and continued to walk over 3 miles per day in unsupportive shoes (converse). In August of 2015, I saw a podiatrist. He did a live x-ray and saw no fracture. He then gave me a cortisone shot and told me to lay off it for 3 weeks. I did, the pain went away and I slowly increased activity, and ran a season of cross country in college. <br /><br />In December of 2015, the pain returned. The pain began increasing from then until in March of 2016, it hurt too much to walk. I used a CAM Boot until June, iced and did PT about four times a week. PT included plantar flexion with a band, Estim around the sesamoid, and graston treatment. Graston helped to work out HEAPS of scar tissue. <br /><br />In June, I saw two other doctors. Two doctors looked at X-rays, which did not indicate any fracture, just lots of inflammation around the sesamoid bone. I got another cortison shot three weeks ago, and have been in a cast since. I took off the cast for about three days to get an MRI (MRI results explained below). It was initially not painful to walk but I still walked on the outside of my foot. By the end of three days, though, I was in too much pain to sleep. My sesamoid was throbbing. I am back in a cast, it's been a week. I'm in the cast so can't currently do the bone stimulator, but I will try to start once I'm out of the cast. <br /><br />Because my injury took place 16 months ago, and I "ignored" it for so long, will non-weight bearing fix it? If it's a stress fracture, will the bone still heal even tho it's been so long? Should I get a sesamoidectomy? <br /><br />MRI results: Doctor told me there is an unusual amount of liquid below my sesamoid bones in my right foot. <br /><br />Here are the results: <br />Technique: 3T MRI. Long axis: PD, PD FS. Short axis: T1, T2 FS. Sagittal: T1, T2 FS, and STIR. The study was targeted to the mid and forefoot including the area of pain. <br />Findings <br />Comparison: X-ray from May 24, 2016. <br /><br />Bones: The alignment of the foot is normal. No acute fracture is identified. There is marrow edema within the lateral sesamoid. This corresponds with the area of pain. No fracture at this site is appreciated. No suspicious bony lesions. <br /><br />Ligaments: <br />Intersesamoid: Intact. <br />Sesamoid-phalangeal: Medial: Intact. Lateral: Intact. <br />Metatarsal-sesamoid: Medial: Intact. Lateral: Intact. <br />Medial collateral: ... <br />Lateral collateral: ... <br /><br />Muscles and tendons: <br />flexor hallucis brevis: Intact. <br />Abductor hallucis: Intact. <br />Adductor hallucis: Intact. <br />Flexor and extensor tendons: No synovial fluid or thickening. <br /><br />Joints: <br />Metatarsophalangeal: Small effusion of the first MTP joint. <br />Neurovascular Bundle: Maintained. <br />Soft Tissue: Crescentic fluid overlies the fifth metatarsal head along the plantar aspect with mild surrounding edema. <br />Impression <br />1. Marrow edema within the lateral sesamoid consistent with sesamoiditis. No fracture appreciated. <br />2. Small effusion at the first MTP joint. <br />3. Normal flexor and extensor tendons. <br />4. Crescentic fluid overlying the plantar aspect of the fifth metatarsal head likely representing adventitial bursitis. <br /><br />Natanya Antoinettehttps://www.blogger.com/profile/04266313626598687276noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-39509139128475062892016-07-27T18:45:35.245-07:002016-07-27T18:45:35.245-07:00Hey Lauren, thank you so very much for your commen...Hey Lauren, thank you so very much for your comment. It has so many questions that I will put a complete answer on my blog over the next day or two. Dr Rich BlakeDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-24174734227166811092016-07-13T06:23:26.176-07:002016-07-13T06:23:26.176-07:00Hi Dr. Blake,
I've had an extremely worrisome...Hi Dr. Blake,<br /><br />I've had an extremely worrisome case of sesamoiditis that has been going on for over 2 years and seems to be getting a bit worse! Over the course of the past 2 years, I continued to run on it because I did not want to stop, but the injury would flare up. I would go through periods of time where I wouldn't run because of the pain and am currently taking another break from running. I went to a foot clinic and they gave me 3/4 length orthotics with dancer pads attached to take the pressure off the ball of my foot but it is not 100% effective. I have also been going to physical therapy but my injury is not going away. I have high arches and due to my biomechanics, my feet have a tendency to lean inward, putting more pressure onto the ball of my foot. I will also add that I have sesamoiditis in BOTH of my feet but it is worse than my left. <br /><br />No healthcare provider has recommended cortisone shots for me, but if I see another, I wonder if it will be. I have an eating disorder and I FEAR weight gain from cortisone shots but hear they are one treatment for sesamoiditis. Do I have other options at this point for healing it without getting cortisone shots? Having a limited ability to exercise has also made it difficult for me with my eating problems. I fear that there is no end to this injury and I will have horrible problems functioning in daily life. I am a college student who will have to walk to classes approx. 3+ miles per day to classes. <br /><br />I have some more questions....<br />Is there a good chance that this is a sesamoid fracture as opposed to sesamoiditis? Would a fracture be worse?<br />I saw in one of your comments that after surgery, one must wear orthotics and dancer pads all the time for the rest of their life....is this true for everyone? My orthotics don't even provide relief in regular athletics shoes, they only work for me in a certain pair of fashion sneakers. If I am limited in what shoes I can wear, what do I do about my professional career someday? Do I bring in a doctor's note saying I have a medical condition that limits which shoes I can wear and take action if I were to receive discrimination based on not being able to wear high heels? What do most professionals who are supposed to dress up do? Also, if I were to get surgery, would I most likely be able to resume running again? <br /><br />Thank you so much, I hope to hear from you. I know this writing is all over the place and jumping from topic to topic so let me know if you would like me to re-write this in a more concise way. <br />Best,<br />Lauren Laurennoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-37919520116771142982016-07-13T05:26:18.282-07:002016-07-13T05:26:18.282-07:00Hi Pam, would you by any chance be able to recomme...Hi Pam, would you by any chance be able to recommend your surgeon to me? Thanks!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-89274564217687477582016-07-10T02:16:21.238-07:002016-07-10T02:16:21.238-07:00Thank you very much for your advice. I am currentl...Thank you very much for your advice. I am currently now on holiday so trying to rest it as much as possible and will be using ice packs a few times a day. If when I return from holiday it's still painful I will return to my doctors. Thank you again for your advice!Anonymoushttps://www.blogger.com/profile/08228989556683206349noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-20322140930840428862016-07-09T18:26:13.791-07:002016-07-09T18:26:13.791-07:00Zoe, sorry for your dilemma. Cortisone shots can g...Zoe, sorry for your dilemma. Cortisone shots can give a 4 day to 2 week flare, and your only treatment is icing to cool the joint down and anti-inflammatory meds. You really have to call that doctor. If you are still in pain, you may need a removable boot for a week or so. Sometimes sesamoiditis is sesamoid stress fracture, so make sure you get an MRI to confirm. You need to keep the foot in a 0-2 pain level for healing. Stationary bike with the weight in the arch is probably okay. Dr Rich BlakeDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-41317741724205089562016-07-04T13:36:13.655-07:002016-07-04T13:36:13.655-07:00Please help I had a cortisone injection for sesamo...Please help I had a cortisone injection for sesamoiditis 2 days ago and am in more pain. I'm an avid fitness person who normally runs at least 5 days per week, go to the gym 2-3 times per week & walk my dogs daily. I was told I can't run for 6 weeks which I'm devastated by but was told I could go on long walks from today but I went swimming this morning & did a very small walk & am in agony.<br />I don't feel I was given any good advice of what I should & shouldn't be doing & as an avid fitness person I'm finding it hard I can't run but at the same time I don't want to risk my recovery.<br />Please advise me of anything I should and shouldn't be doing. Anonymoushttps://www.blogger.com/profile/08228989556683206349noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-57332290432936300542016-05-19T18:39:16.019-07:002016-05-19T18:39:16.019-07:00Thank you so very much for your comment and I am s...Thank you so very much for your comment and I am so sorry for you dilemma. The 5 point approach of stable shoes, taping, orthotics, muscle strengthening (start with metataral doming in the evening), and consideration of prolotherapy (injections of sugar water into ligaments). Even if you go to the Sole OTC heat moldable orthotics that would be a good start. Get a roll of kinesiotape and start experimenting with digital taping or see a physical therapist in your area to help you. Here is a link. Keep me in the loop. Rich<br />https://kinesiotaping.com/how-to/kinesio-tape-foot-instructions/Dr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-54334238263503542102016-05-18T12:47:46.882-07:002016-05-18T12:47:46.882-07:00I have been to several podiatrists and orthopedic ...I have been to several podiatrists and orthopedic foot and ankle doctors, all telling me that I have hypermobility of the forefoot. The muscles in my feet hurt so much, as they are working so hard to stabilize the hypermobility and they are so tensed up. I have been told to fuse the bones or orthotics. I had gone the orthotic route for six years and once I got out of them, my feet have been killing me ever since. The orthopedic doctor told me that the ligaments and tendons were not strong enough to support my weight. I am thinking fusing bones or another pair of orthotics is not going to help. Doctors do not think outside of the box, as I know I have alignment problems. I had left hip and pelvic pain for 20 years. I have go to PT, chiropractors, acupuncturist but no one seems to be helpful. <br /> <br />My toes are literally grasping the ground, I have been told this is happening because of the hypermobilitity. My feet are literally exhausted as they are taking the blunt of my walking. I have tried exercising my feet but they hurt even more. I have been told that exercising the feet will not help with the hypermobility of the forefoot. I have so many trigger points in the calves, legs and hips. My knees are killing me also, I do trigger point everyday just to relieve the tension throughout the body. I just cannot seem to find someone to help with my feet issues without surgery or orthotics. I do not want either one. <br /> <br />Is there anyway to tape the hypermobility of the forefoot just to get relief of the tension in the feet and legs. I am literally walking on the bones of my feet and I have developed bunions and hammertoes, one bunion is so painful as I am walking on it. I am extremely exhausted from all this. <br /> <br />I used to be an avid runner, now I cannot even walk more than 10 minutes. <br /><br />Is there a way to tape the feet for hypermobility of the forefoot?<br /> <br />Anonymoushttps://www.blogger.com/profile/00621324478799330912noreply@blogger.com