tag:blogger.com,1999:blog-673715911736059911.post8077641935735209850..comments2024-03-28T02:42:33.170-07:00Comments on Foot and Ankle Problems By Dr. Richard Blake: Sesamoid Fracture: Email AdviceUnknownnoreply@blogger.comBlogger4125tag:blogger.com,1999:blog-673715911736059911.post-37399640566941543982015-11-25T15:18:05.568-08:002015-11-25T15:18:05.568-08:00Just email with post url to drblakeshealingsole@gm...Just email with post url to drblakeshealingsole@gmail.comDr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-13855885286666126732015-11-25T15:15:05.628-08:002015-11-25T15:15:05.628-08:00Yes, with subsequent fracture/separation there wou...Yes, with subsequent fracture/separation there would have been increased swelling with a 4-6 week setback. She sounds like she is doing well. The small stress fractures vs stress reactions are normally healed in 4-6 weeks of immobilization, but very sensitive for another 6 months. Especially in hard arched feet with their increased ball of foot pressure. You can get a stress fracture in a bipartite sesamoid, so the most important thing is the edema in the sesamoid. That edema is our enemy since it makes the bone very sensitive, and can cut off the circulation to the bone. Twice daily you should ice pack the bottom of her foot for 10 minutes, and once daily do the 20 minutes of contrast bathing. This will make sure the fluid is not trapped in the bone. You or she should massage the area twice daily for 5 minutes to desensitize the tissue. It must be pain free massage. It will hurt for the next year to push on, so that is a poor indicator of how she is doing. She should have dancer's pads in all her shoes. You can purchase the 1/8 th inch adhesive felt from www.mooremedical.com. Hope this helps. Also see if spica taping with 1 inch kinesiotape helps. Rich Dr Richard Blakehttps://www.blogger.com/profile/14832893709341945125noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-22568687703681867012015-11-24T18:09:44.919-08:002015-11-24T18:09:44.919-08:00I am not sure how to add images to my previous pos...I am not sure how to add images to my previous post on sesamoid vs. bipartite questions. Let me know how and I can send these along.<br />Thanks.Jayhttps://www.blogger.com/profile/17963541983766301490noreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-42190754004609963822015-11-24T17:24:31.739-08:002015-11-24T17:24:31.739-08:00Hi Dr. Blake,
From all that I have read here and e...Hi Dr. Blake,<br />From all that I have read here and elsewhere it can be difficult to tell from an Xray if a sesamoid is fractured or bipartite. My daughter had a sore toe one day four months ago, played sport and seemed fine but then awoke the next morning and could not walk on it. The MRI showed a stress response with no fracture line or fragmentation. She wore a boot for 3-4 weeks but then resumed a bit of sport with more rest and ice in between. We determined she had modified her gait and started avoiding push off the first MTJ on her injured foot. Note, she also has a high arch foot type. We had an xray taken more recently that showed two parts to the medial sesamoid (only on that foot). The parts look like they fit together to me but the xray report didn't say anything about a fracture or bipartite and the podiatrist that ordered them wasn't concerned either. Note also that the other foot does not have a bipartite sesamoid. <br />Since doing all this research and learning that this diagnosis can be confusing I thought about looking at the MRI to see if I can tell if it was split/ bipartite at the initial time of injury. It looks like both sesamoids are whole to me in the MRI at that initial time but is that a valid image to assess as it was all bright with oedema? She is now able to walk without pain and do a fair bit of activity without pain, however it always hurts to press on it from the side. Could it be a fracture? The only time she had massive swelling and pain was the initial time of injury and the MRI showed no fracture or fragmentation. She did have a few small setbacks in the initial weeks after removing the walkable boot but we iced and seemed to recover well so I am not sure when a fracture / separation would have occurred. If a subsequent fracture / separation occurred would there have been another big pain and swelling or could it have been more subtle?Jayhttps://www.blogger.com/profile/17963541983766301490noreply@blogger.com