Healing Sesamoids!!!

Hi Rich!

Just wanted to send you an update on my sesamoid injury. I'm doing great! I can walk barefoot when I'm staying indoors (been doing so for several weeks), and I can use regular footwear when walking short distances (although still good shoes, just without specific sesamoid protection). Without any significant pain, of course. I'm still using the Hoka shoes with orthotics when walking longer distances, for example an hour's walk. 

Still, I have to admit I haven't been as good as I should be at following up the contrast baths and foot exercises regularly. The reason for that is that I'm pregnant, and I've been feeling really tired and sick at the beginning of the pregnancy. Despite this, I've used Exogen every day and I've been doing the contrast baths and foot exercises regularly again for the last six weeks. Also, because of the pregnancy, I can't have any images taken of my foot, therefore I don't know what the fracture looks like at present. 

I feel like I can mostly do all sorts of activities again, but I still can't run without pain and I can't go for long walks without protective foot wear. Should I continue on with foot exercises, contrast baths, etc, any specific exercises I should pay attention to? Is there anything I should do differently now when I'm doing much better? Do you have any advice on footwear at this point? 

Dr Blake's comment: Thanks for the great news. For our reader, I placed your original posting 9 months ago below. And, congratulations on the pregnancy!! I wish you all the best for a healthy and happy little one. I just love my grandson, and we have 2 boys. Boys, boys, and boys. Lucky we have a wonderful daughter in law, and my other son just got engaged to a good soul!!
     As you feel better, and have other issues, it is easy to be lax at what you do. As long as you are doing the Exogen (and 9 months should be perfect) you want to do the contrast bathing 3 times a week as a deep flush. Ice also once a day now just to keep the inflammation under control. You should be able to do a walk run program with the Hokas by now, so if not, you may need a separate orthotic device with higher arch and more dancer's accommodation. And, some of my patients need to spica tape and use cluffy wedges to run also. But, gradually building up to 30 minutes running is the next step in your healing. You need to review the walk run program I have on the blog. As you return to full activity, you need to keep up a 10 minute daily routine of strengthening: single leg balancing, met doming, heel raises are normal. Make sure your achilles are stretched out because tight achilles lead to more forefoot pressures. Keep up the healthy diet, Vit D if you are not in the sun enough, and any other bone supplements you take. I have my patients alternate walking and alternate running with the Hokas and more normal but stable shoes that bend easily in the front at the ball. By alternating, you really get a feel of how important the Hokas are to limit the bend. You should slowly need that protection less and less. 
     As you walk with any shoe and orthotic, feel where the weight is going through the front. If it is entirely on the first, either ditch the shoe or modify the orthotic. Then weight should be even 1st and 2nd mets, or all the way across the front of your foot. I sure hope this helps some. Congrats again. Rich

Hope you're doing well and having a great summer!

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Caroline Jordan: More Reflections on her Sesamoid Healing

Caroline is a gifted fitness professional who developed a devastating sesamoid injury one year ago. This is part of her wonderful reflections on her own problem with the hope it can help others. 

https://youtu.be/yruHwHCnSFU

Slow Sesamoid Healing with Symptoms: Email Advice

This email was sent by a patient gradually improving from a sesamoid fracture with some nerve and inflammatory symptoms. 


Dr. Blake,

Happy New Year!  How are you doing?  I hope all is well with you!   If you have some time, could u help me out with answering a few questions.  Thanks a million!  Tom

Questions:

1.)    Request for MRI, for the following reasons:

Big toe sometimes feels sore, and when I flex it, I feel a very mild soreness there, and also where the sesamoid fracture is.

Warmth radiating along the entire side of my foot (the right side)

When I stand on my tippy toes, it feels sore on the big toe, and also the sesamoid area (pain level 1-2)

2.)    Can peripheral neuropathy be taking place, and if so, how can we rule this out?

3.)    Can I do physical therapy to strengthen the area, or will this make the break worse?

4.)    Sometimes, the top of my big toe, throbs.

5.) since this fracture was not identified until 6 months later, do I have less of a chance of it to heal?

6.) can it ever heal, and if so, what is the time frame?

Thanks!

Dr Blake's Response:

Hey , I'm doing well. My wife and I just got back from a week in Hawaii, so life is pretty good. Thank you for asking. I glad your symptoms are getting better. You want followup MRIs 6 months or greater apart to check healing, so you should be getting another one soon. Peripheral neuropathy is abnormal nerve sensations, typically on both sides. There is a nerve biopsy they do now on the lateral side of your leg, but I am unaware of what podiatrist do it. No, as long as there is no jumping or impact forces you are fine to get physical therapy. The therapist has to be aware of your fracture and they spend alot of time strengthening the core as well as the foot and ankle. Delayed diagnosis can delay healing, time frames are hard. I use functional guidelines while I wait the 6 months between MRIs. These guidelines include a progression of function: when you can get out of the boot, when you can walk 30 minutes without pain, when you can finish a walk/run program? We should see gradual improvement, and make changes if necessary if we hit plateaus. Rich