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Both sesamoid bones broken on both feet

bipartate sesamoid

bipartate sesamoid

I have recently been told that I have fractured both sesamoid bones in both feet 8 years ago. As I had pain in my feet as well I was diagnosed with CRPS and can hardly walk without using 2 crutches. I have had every treatment possible but nothing has helped and I have to take lots of medication just to get through the day. I have had surgery to remove a large lump on the bottom of my foot and have had numerous xrays over the years. I was sent to an orthotics clinic when my ankles began to collapse and the doctor there got out my old xrays and began to show me the fractures, assuming that I knew about them. When he took impressions of my feet he told me that due to the fractures my right leg was out of alignment and would need correcting. The 2 bones on my left foot are still together but are cracked down the centre. On my right foot 1 is still together but the other is open.When he realised that I didn't know he quickly began to back peddle and told me to talk to my GP. Is it too late to solve this problem? No one wants to take responsibility for this and it is not recorded anywhere because the orthotic doctor says its not up to him to record it.


RESPONSE

Hi Tracy,

I realize I am only getting your side of the story and obviously I do not have access to your records and more importantly your x-rays, but your narrative does not make sense to me.

I am not sure how you could have fractured both sesamoid bones in both feet. Unless you fell from a high position and landed on both feet the wrong way, it is virtually impossible to fracture all four sesamoids.

Yes, with Complex Regional Pain Syndrome, over time your bones will become osteoporotic and
so they will be demineralized and therefore weakened which would subject them to a higher incidence of fracture, but that would also pertain to all the bones of your feet and possibly your legs as well. You do not mention having had fractures any where else.

So strictly on a percentage basis, the odds of fracturing four sesamoid bones, with no history of trauma and from simply walking seem far fetched to me.

Why did the doctor tell you all four bones were fractured? Maybe he is reading the x-ray wrong. What I mean by that is there is a condition known as bipartate sesamoids. In this condition when the sesamoid bones are formed, instead of each one forming one bone, they form two instead.

To the uninitiated they will appear as fractures when in reality they are actually two bones. That would be the only logical reason why you were never told you had fractured these bones, simply because they are not fractured.

The other problem is that in most cases, but not all, it is very difficult to see fractured sesamoids on x-ray, unless again, there was severe trauma and you really crushed them. In many instances, a bone scan or even an MRI is necessary to determine if there is really a fracture or not.

I think the best advice I could give you is to have your x-rays reviewed by a podiatrist or an orthopedist for a more accurate reading. Your GP is not the person to resolve this.

If on the chance you actually have four fractured sesamoid bones, there is probably nothing you can do to get them to heal at this point as they would be considered a non-union of eight years duration and I cannot think of anything you could possibly do other than have an orthotic made to take pressure off of the bones, in the same manner that we treat sesamoiditis.

Marc Mitnick DPM
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