I broke my tibial sesamoid about 9 months ago. It’s been a long, bumpy journey, so I thought I’d put the experience to words for those out there suffering from a fracture of the tibial or fibial sesamoid. This blog will cover the medical components to healing a sesamoid as well as the psychological challenges facing a person with a fracture whose trajectory is so uncertain and rate of healing only 50%.
When I started this journey, in July 2010, I found a dearth of research on sesamoid fractures, and of what does exist, much of it is conflicting and most of it anecdotal. As a result, there is no clear expert consensus on how to heal a sesamoid fracture. Most patients aren’t aware of this and are at the mercy of the opinion of their practitioner (who herself is lacking the guidance of solid research). In other words: healing the sesamoid is part luck and part clinician’s knowledge based on experience and anecdotal evidence. Since these bones have such a high non-union rate (where the bone does not re-attach to itself, i.e., heal), and since anecdotal evidence reveals quite a variation in the healing patterns, the bottom line is, there is no known best practice in healing a tibial or fibial sesamoid.
After the initial x-ray of my foot, I was fortunate to have been privy to a debate between 2 podiatrists as to whether or not it was necessary to cast my foot. Their debate inspired me to do my own online research so I could form my own opinion, and what I found led to me to choose a very conservative treatment plan that was somewhat of a middle ground between the two options (camwalker boot, or cast). I’ll go into depth on the plan later on.
In ancient times, the sesamoid was once posited to be the “seat of the soul.” The door to the soul, I’d say. These two little pea-sized bones located in the ball of the foot (there are 2 there, the fibial and tibial sesamoids), are like a “lever” upon which we walk. The majority of the body’s weight passes through the sesamoids, and they allow you to shift your weight from the heel and arch of the foot to the toes with each step. Without the tibial and fibial sesamoids in good working order, well, it’s hard to walk. Or to do much of anything that requires ambulation. During those long months when it was uncertain as to whether I would be in the 50% healing camp, or 50% non-union camp, I felt my soul shrivel, my life force shrink, and my joie de vivre disappear. Movement, I’ve learned, is the door to my soul. And breaking this teeny bone can have such a profound impact on one’s ability to move.
So — healing it became my mission, focus, and obsession.