Post-Sesamoid Fracture: Addressing Inflammation And Pain While Transitioning From A Walking Boot Into Shoewear And Orthotics

A patient contacted me after suffering a non-displaced medial sesamoid fracture in his right foot in November 2017. Since December 2017, he has been in a walking boot but has made zero progress over the first few months.

He started taking vitamin D in March 2018 and his symptoms started radically changing. The patient indicated that the injury finally started to feel like it was “healing.” A blood test revealed his vitamin D level was low at 26 ng/mL. He increased his vitamin D dosage and has been maintaining it around 50-60 ng/mL for about three months. 

Over these last three months, the patient says the pain has been primarily due to the inflammation and blood flow going to the forefoot. He says he has been able to mitigate this by keeping the foot elevated and icing it occasionally. The patient has maintained a 0-2 pain level on the Visual Analogue Scale and feels like he is able to transition slowly out of the boot. At this point, the patient is able put more weight through the ball of the foot (in the boot) simply because the inflammation is a lot milder than it was three months ago. The patient asked that as he transitions into a stiff-soled shoe with orthotics, what are the primary signs that he should go back into the boot again temporarily?

I encouraged this patient to maintain the 0-2 pain levels throughout his rehabilitation. He should look for patterns of what increases the pain and avoid the causes of pain for one month before retesting that benchmark again. As the patient transitions from the boot, I advised him to ice the foot twice daily whether or not he feels like it and take contrast baths each evening. 

The patient also asked if recurrent swelling is common during this transition period and after the transition period. Swelling produced by an injury is a bell-shaped curve. Some people swell a lot and others do not. Swelling per se is not that important but pain is. I explained that if the foot swells but does not hurt, it is no big deal. I also emphasized the importance of icing, contrast baths and non-painful massage on a daily basis.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2018/06/sesamoid-injury-controlling.html . It is reprinted with permission from the author.