Exogen Bone Stimulator: Dramatic Help for my Patients

     If you read my blog you know I love the Exogen bone stimulator since it strengthens bone. I have hundreds of patients benefit with healing at a faster pace then expected, or healing when no improvement was expected. It is not a cure all. But when you want to try to give a bone injury a chance to heal, especially in my sesamoid injury patients, Exogen is my go to Bone Stimulator. Most sesamoid injuries are within the bone and there is not definite fracture line or gap. The goal is to get bone stronger, which is all I care about, and symptom relief seems to follow. 

https://fda.report/GUDID/M937710344001

Standard Sesamoid Fracture Treatment Orthopedic Viewpoint

     This is the standard sesamoid treatment in the podiatry/orthopedic world. It is standard of care, but there are so many other options available. Unfortunately, surgery is the norm for many treating physicians, and I know this is only a superficial article by a brilliant doctor. I read any and all articles on sesamoid injuries, because I am always trying to have one more trick in my ability to heal sesamoid fractures. This week I have had 3 patients come in that I successfully treated for sesamoid fractures over the last 20 years, going back to full activity, and without the need for surgery. They were not in the office for the sesamoids but for another problem. If you have a sesamoid fracture, please read through this blog for the 30 common aspects of treating sesamoids. Perhaps you can send me a tip that you have found vital to your healing or the healing of your patients. The basic message with ball of the foot pain is to get to a diagnosis early, create a 0-2 pain level quickly, and do not settle for providers telling you that if you are not better in a specific period, then surgery should be done. It definitely has taken me over one year in most cases to decide on surgery in the less than 5% of all sesamoid fractures I see.

https://www.anklefootmd.com/how-to-treat-a-sesamoid-fracture-in-your-foot/

Sesamoiditis turning into Fracture: Email advice

Good evening Dr. Blake,

I am currently a student at a university. I suffered sesamoiditis in February of 2018. I visited the doctor and they took an MRI and Xray, and he said it was sesamoiditis. They gave a steel toe plate to insert in my shoe so I don't bend my toe too much and it did help for a little bit. A couple of months went by and I got used to the pain.
Dr. Blake's comment: I hope you understand that we must get the pain to 0-2, not just be helped, or you will not heal potentially. This is especially true with sesamoids that are slow healers in the first place.


I did try to ice as much as I can and the pain went away. I am a pretty active person, and just couldn't sit out during the summer while I trained. I didn't think much of the injury since it was a busy summer for me and didn't know that it is that big of an injury. I trained and ran with it and played basketball with it all of 2018. I adjusted my gait so I don't put pressure on it and that lead to other problems such as calf tightness and knee pain and hip pain.
Dr. Blake's comment: Thanks for being honest. I know we all try to just live with it with the eternal hope that it will eventually get better. At your age, I would have been doing the same thing, so no guilt allowed.




I stopped playing around a couple of months ago since I knew it wasn't really healing so I didn't want to risk it (Which I already did by running on it that whole summer.) I visited the doctor on 1/30/2019 and he took an X-ray where it was found that I completely broke it. The doctor said I have to get a procedure to take out the bone ASAP and referred me to a surgeon. I talked to the surgeon and he basically just told me about the recovery time and things of such and I told him that I read some people never return to 100% and he agreed and told me to just sleep on the option of surgery. He also said it has no chance of healing since there is no blood supply to this area. It doesn't look like it is a huge break, but is there a chance of it healing without surgery and could it union? I attached the X-ray picture to this email. I came across your blog because I was desperate and it has been so helpful. Please get back to me. 

Thank you so much

Even though this is alittle blurry one can see the obvious crack with jagged edges

Dr. Blake's comment: Okay, you got yourself in a bind. Please understand that there is no gap between the fragments, so the bone contact is good for healing. Yes, these heal slowly so the rest of this year will be dealing with your sesamoid in one way or the other. I am sorry when some of my patients need surgery after a long battle, but since the majority heal fine, the battle is always worth it. Plus, even if you need surgery, you will have the orthotics and dancer's padding that will protect the other sesamoid in high impact sports your whole life.

     So, you have to create the 0-2 pain level, get a bone stimulator, start doing daily contrast bathing for swelling reduction which improves circulation, get a Vit D test to make sure you are fine there to heal a fracture, eat healing, cross train with biking, swimming, flat footed eliptical, get Dr. Jill's dancer's padding at 1/8th inch and 1/4 inch for various shoes, get good custom orthotics to take pressure off the sesamoid, and learn spica taping and cluffy wedges and see if important for you. Some of my patients love some of the Hoka One One shoes, but that depends if the roll is in the right place. Zero drop shoes are better in general than traditional shoes. I hope this points you in the right direction. Rich





Foot Pain from Hamstring Stretch: Probably Nerve Irritation

Rich,

     Your treatment plan for the fractured sesamoid in my left foot is going well, especially since I got Dr. Jill's 1/4" felt met pads, which work better with your orthotics than the 1/8" felt I was using for months. I've been able to increase my weekly walking distance gradually to about half what it was before the injury, but last week I suddenly developed a new problem in the right heel which has immobilized me again.
Dr. Blake's comment: Thank you for that feedback. I will try to tell all my sesamoid patients to experiment with the Dr. Jills product, even with their orthotics. So happy you are off the long plateau you were on. 

     Before starting a hike, I was doing a standing hamstring stretch with leg elevated onto the tailgate of my truck (I had already done my other stretches, including the "wall" stretch for calves). Toward the end of the stretch, I flexed my toes back toward my knee, and when I set my foot back on the ground (wearing heavy hiking boots and orthotics as always), I felt a sudden sharp pain in my heel.
Dr. Blake's comment: This is nerve irritation at the end of the sciatic nerve branch that feeds the bottom of the heel. The sciatic nerve is most stretched, and potentially irritated, with the hip flexed, the knee straight, and the ankle bent. Maximum stretch. It only takes slightly bending the knees or not pulling up the foot towards your chest, or both, to relax the nerve. So, you irritated the nerve deeply. 

Here similar situation with hip flexed, knee straight, and toes pulling up towards knee

     I had no idea what was happening and went on with my hike, being super-mindful about walking slowly, taking short steps and trying to focus weight away from that heel and onto the arch and toe, meanwhile just feeling discomfort in the right heel rather than outright pain. But the next morning when I woke up, I couldn't put any weight on that heel without bad pain.
Dr. Blake's comment: Have you a history of sciatic on that side or any low back or spine in general issues? These can be the first low grade irritation, that makes the sciatic nerve grouchy, but the stretch does you in. Nerves love motion, not prolonged stretches. 

     I ALWAYS wear your orthotics with the heavy boots, except when in the shower, and I've been really good about stretching, so this new problem really stumps me. The pain is under the center of the heel, and gets worse as the foot flexes and the back of the leg stretches (e.g. when doing a "wall stretch"). You say on your blog that PF develops slowly, so I initially thought it might be bursitis. But I don't do anything that results in impact on the heel - all I do is walking. And the pain seems to have been triggered simply by a routine stretching movement.
Dr. Blake's comment: Yes, see my video on neural flossing, get some Neuro-Eze to massage 3 times a day, avoid  low back, hamstring, or achilles stretching until it is better. Lift everything with your knees bent. Soak in warm water to see if it helps. Give me feedback within the next 2 weeks. 

I've been doing the ice bottle roll combined with mild stretching for a week with no improvement. I understand these things are sometimes tough to diagnose, but in any event I haven't had good results with our local podiatrist and thought I'd run it by you first. Feel free to post to blog if desired.

Thanks,



https://youtu.be/E0E60NpOSHg