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When Sesamoiditis Progresses To A Fracture

A patient contacted me after being diagnosed with sesamoiditis over a year ago. His physician gave him a steel toe plate to insert in the shoe so he will not bend his toe too much. The patient notes the plate did help for a little bit.

A couple of months went by and the patient says he got used to the pain. In these situations, we want to get the patient’s pain to 0-2 on the Visual Analogue Scale or the patient may potentially not heal. This is especially true with sesamoids that are slow healers in the first place. The patient iced the injured area as much as he could and he said this helped the pain. He is a pretty active person. The patient said he trained and ran with the injury, and played basketball with the sesamoiditis through all of 2018. He adjusted his gait so as not to put pressure on the injured area, which led to other problems such as calf tightness, knee pain and hip pain. The patient curtailed his activity a couple of months ago since he knew the foot was not really healing so he did not want to risk further injury. He visited the previous doctor on Jan. 30 and an X-ray revealed a sesamoid fracture, for which the doctor recommended surgery. The surgeon  said the foot has a chance of not healing since there is no blood supply to the area. The patient wants to know if there is a chance of the seasamoid healing without surgery?

In reviewing the X-ray the patient sent, there was no gap between the sesamoid fragments and I let the patient know the bone contact is good for healing. Yes, these sesamoid fractures heal slowly so the rest of this year, the patient will be dealing with the sesamoid in one way or the other. Plus, even if this patient needs surgery, he will have the orthotics and dancer's padding that will protect the other sesamoid in high-impact sports his whole life.
In order for this patient to attain an 0-2 pain level, I recommended using a bone stimulator, initiation of daily contrast bathing for swelling reduction to improve circulation and getting a vitamin D test. I also recommended cross training with biking, swimming and a flat-footed elliptical.

I also recommended using Dr. Jill's dancer's padding at 1/8-inch and ¼-inch for various shoes, getting good custom orthotics to take pressure off the sesamoid, and looking into Spica taping and Cluffy wedges. Some of my patients with sesamoiditis love some of the Hoka One One shoes. In my clinical experience, I have found that zero drop shoes are better in general than traditional shoes for patients with sesamoiditis.

Editor’s note: This blog originally appeared at . It is adapted with permission from the author.

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