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sesamoid fracture

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In 1997 I injured the metacarpal joint of my left foot playing judo (lateral hyperextension of the big toe). At the time it was extremely painful, but the doctor said it was only a sprain. It continued to hurt for 16 months (during which I returned to the hospital frequently to check it)until another doctor finally caught the fracture of the inner sesamoid on the X-ray. He sent me to an orthopedist who told me the only option other than “wait and see” was to remove the sesamoid completely.Now its 7 years down the road, and it frequently feels alright. Then I will step on it wrong feel a sharp pain which usually sends me to the ground, and it will ache for months. The problem has completely interupted all of my prior sporting activities (all based on the ball of the foot). Removing the sesamoid would solve the pain (from what I understand) but I still would not be able to play judo, run, mountain climb, or any of the other sports I love. Are there any other options? Is there anything I can do to facilitate the wait and see approach?-Andy

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  1. As you are aware, a sesamoid fracture is difficult to diagnose and quite annoying for such a small bone. Most of the time, immobilization will allow healing. Frequently what occurs is an asymptomatic non-union. Scar tissue forms between the broken pieces and if it is strong enough, then the pain goes away.I am guessing that you do not have a completely strong fibrous union which periodically gets reaggravated. Removing the sesamoid is one option. An orthotic with a cut out under the sesamoid might be helpful.

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