Today on the Doc On The Run Podcast, we’re talking about sesamoid stress reactions and the expected healing time.
I got a question from an injured runner, and she wants to know about the amount of time it takes to heal a stress reaction in the sesamoid bone in your foot. Sesamoid bones are just little bones that are half within a joint, half out of a joint, and embedded in a tendon and I know that sounds complicated, but if you want to see what one looks like, just look at your kneecap, that is the largest sesamoid bone in your body.
You have two of them underneath your big toe joint. The inside one is called the tibial sesamoid because your tibia is on the inside of your leg, and the outer one is called the fibular sesamoid because your fibula is on the outside of your ankle.
She has an injury, and she says, “I have had a stress reaction in my tibial sesamoid that led to a lot of pain and swelling. I am reading mixed reviews on healing time. I have been off it for three weeks now, either on crutches and taping the toe to immobilize it or in a walking boot with tape on the toe and sesamoid dancing pads to avoid pressure on the bone.”
Now, really, I will stop right there and just say, okay, this is multiple treatments she’s talking about, and she wants to know how long can I expect healing to take. I am a 38-year-old healthy female. Okay, well, that’s a lot of information, but unfortunately, it doesn’t include the crucial pieces of information I need.
You cannot figure out the amount of time it’s going to take you to heal unless you know all the variables. I understand you want a simple answer like four weeks or six weeks or something like that. However, you’re not going to get that. The bone is going to change its healing rate based on number one, the severity of the injury. So, if you have a really severe stress reaction, it is going to take longer to heal than one that’s really mild. This is not complicated, and it also is a fact.
Things will heal faster if you’re super healthy. Things will heal faster if you’re sleeping well, if you’re hydrated, if your nutrition is good, if you’re destressed, if you’re not emotionally taxed, if you’re rested. The only variables I know here are that number one, she’s 38 years old and she says she’s healthy.
Healthy by what standard? Healthy by an athlete standard? Healthy by uncontrolled diabetic overeater standard? There are wide variations on healthy. Healthy for somebody who doesn’t have celiac disease or some digestive disorder that prevents you from taking in nutrients. Somebody who doesn’t have pituitary gland dysfunction or thyroid dysfunction.
It’s presumed she doesn’t have those things, but I do see people who get recurrent stress reactions who do have some of those things and never knew it. So, the time that it’s going to take to heal will vary widely. What she’s basically asking me is if I’m healthy and 38 years old and I have a tibial stress reaction, how long will it take it to get better? Well, that depends.
First of all, you haven’t really been off it for three weeks if you’re on crutches with the toe tape part of the time. If you’re in a walking boot, you’re walking. You’re not on crutches. You’re walking. That’s not being off on it. The reason I know that she must be walking on it is because she says that in addition to using the fracture walking boot, she has a dancer’s pad to remove pressure on that sesamoid bone that has the stress reaction. Those are two completely different things.
Someone who uses crutches and immobilizes the foot for three weeks with it taped, with it immobilized and all of that will heal faster than somebody who is walking on it in a fracture walking boot with dancing pads. That’s for sure. She’s not really doing any of those for the past three weeks. She sounds like she’s done part of them for some of the time and part of them for some of the other time, but I would never base the treatment or the change in treatment based on a time frame like that because of all the variables I just gave you.
What’s really crucial is when you have a sesamoid stress reaction that you talk with your doctor about number one, your goal, what is your actual goal and number two, you need to pin them down on the severity of the injury because the severity of the injury is going to dictate the severity of the treatment. The biggest mistake that doctors make is focusing on your injury, the sesamoid stress reaction, as opposed to the goal which might be to complete the Boston Marathon or some other thing that you’re signed up for. The biggest mistake you as runners make is not figuring out how severe the injury is.
If you want me to show you how to do that, you can go and get a thing to download because if you called me for a consultation, I asked you a whole bunch of questions, about 20 of them actually, and I put all of those questions that you should be asked by your doctor and if your doctor didn’t ask you, you should ask yourself and take it to your doctor to say, well, this is what I really see. How do you factor this into my treatment? How can we speed it up based on these answers?
You can get that stuff for free at www.stressfracturesecrets.com. It basically will help you work through and figure out how severe your injury is right now, and it is going to be different now than it was three weeks ago before you started using crutches, started using a dancer’s pad, started using tape, or anything else to treat the stress reaction. You’ve got to figure out how severe it is. If you really want to get back to running, that’s the best way to do it.
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