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Questions related to sesamoiditis/ sesamoidectomy

Discussion in 'Ask your questions here' started by Unregistered, Aug 11, 2010.

  1. Unregistered

    Unregistered Guest


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    I am a 27 yr old female who has been diagnosed with sesamoiditis and possible sesmoid fracture in my bipartite medial sesamoid in my left foot. I went first to my regular doctor in mid June when I noticed that the ball of my left foot was much larger than the ball of my right. It was around this time that I also noticed a slight pain whenever I put pressure directly on the ball of my foot and also that my ankle/ shins were tight and sore (from inadvertently walking more on the outside of my left foot in order to not put pressure on the ball). My regular doctor did an xray and noticed what he thought was a stress fracture in medial sesamoid. He recommended I see a sports medicine doctor which I did. He put me in a walking cast for 3 weeks. He never recommended I ice, elevate, or take ibuprofen for swelling. I should also pause to mention that I never experienced great pain like many other people who have posted about sesamoid problems. My pain was primarily when I put direct pressure on the ball of my foot - like when running, or standing up from an indian style position. My main problem at the beginning (and it has continued to be my main problem) was the swelling of the ball of my foot which caused me to walk on the side of my foot instead of in a flat/ normal way. After two weeks of the boot making my foot worse- pain and swelling wise-, I called him and he set up an MRI. The MRI results are confusing as they say that there is no fragmentation of the bipartite sesamoid, but later talk about the "sesamoid fragments" and also mentions bone edema which my podiatrist says is often an indication of a bone event. So, as I was still trusting the sports medicine doctor's opinion, I took his advice and was on crutches for a week but also set up an appt with a respected podiatrist in my area who deals with sports injuries and works with a local college's athletics dept. He said that immobilizing the foot wasn't a great idea, gave me a cortisone shot, and prescribed PT. He also prescribed a night splint and indicated that I might have sesamoiditis or I might have a fracture... he said there wasn't much way to definitively say.

    So I've been going to PT for 3 weeks, getting ultrasound and some sort of magnetic steroid machine treatment along with strengthening exercises. This seems to help, but when I began to put more weight on the ball of my foot (not from exercise, just from normal, limited walking), the ball swelled up again. Not as much as when I first went in to PT, but more than my previous visit to my physical therapist. As the podiatrist had instructed me, I called him when the ball re-swelled. He gave me another cortisone shot, but indicated that if the 2nd cortisone shot and a few more PT sessions didn't work, then surgery would be my only option. The physical therapist indicated that in her experience(which I realize is not the same as the podiatrist's), some swelling can occur and isn't a sure sign that it won't heal or that it will definitely require surgery.

    So now for my questions:
    I have been wearing the night splint as much as possible but cannot fall asleep with it on. I've probably been averaging 3-5 hours in it a day. I forgot to ask my podiatrist the last time I saw him what the rationale is for the night splint and an idea of how long I should ideally be wearing it a day (I'm assuming 8 hours?)
    Also, I've gone to 6 sessions of PT and have had lots of relief from the treatments and have felt good after the exercises, but I'm wondering if this is because I still was avoiding putting weight on the ball. How effective is physical therapy generally at treating this issue (assuming it is just sesamoiditis and not also a fracture?) How long would be a reasonable amount of time/ sessions to rule out its effectiveness?
    Finally, if I eventually choose to do the surgery, and limit/ restrict some of my former/ high impact activities (like running... I actually never liked it anyway so that's fine!), can I reasonably expect to be able to walk/ hike like before? I usually take my dog for an hour of walks/ hikes a day and also walk to and from work (probably 10 mins each way). I like being on my feet and doing lower impact activities and I'm scared that surgery might limit or restrict me from even these "gentler" activities.

    I realize that anyone with advice/ experience with this can't diagnose me or give me definitive answers, but I would really appreciate any general advice/ knowledge you could share. I've been cooped up in my house all summer and I've finally reached a point where my positive attitude is failing me. Thanks!
     
  2. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS- ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************
    These are not the sort of questions which lend themself to the response you solicit in a venue such as this. You state initially that you have been diagnosed with sesamoiditis and possible sesamoid fracture in your bipartite medial sesamoid, but the details of your post do not seem to support a clear definitive diagnosis. I have to wonder why, if the podiatrist was uncertain as to whether you had a fractured sesamoid, he injected a corticosteroid, as, in my view, that would have probably been unwise in the presence of a fracture. There is little point in suggesting how long and what disability might occur after a surgery which has not been clearly defined and is for an uncertain condition. Yours is clearly a case for which general advice would not likely be helpful and will have to be left to the attending doctor(s). Regarding the night splint questions, did it not occur to you that your doctor who should know the exact answers to his rationale for its use, how long it should be used probably has a telephone. I really will never get the rationale as to why patients who fail to ask their treating doctor questions specific to his/her care don't simply ask him/her, even if they have left the office instead of asking someone who did not make that care decision.
     
  3. Unregistered

    Unregistered Guest

    He is in surgery today. That's why I didn't call him. You seem to need a vacation. I understand that this isn't an ideal location to get answers, but I'm not sure how snarkiness helps anyone?
     
  4. FootDoc

    FootDoc New Member

    Gimme a break, lady . . You've been dealing with this unresolved problem since mid-June, going to several doctors and a PT, and now you say that you couldn't wait until tomorrow to get an answer to a question that can be best . . . maybe ONLY answered by your own doctor who prescribed the treatment. If you think that telling you how best to obtain case-dependent information is being "snarky," then you are in denial about the necessity to be pro-active when dealing with your doctors and your medical problems. If, as I suspect, my frankness might just get you on the phone first thing tomorrow morning, then my job is done here. If it hasn't done that, you'll probably still be in a funk regarding your condition months from now.
     
  5. This message is for the original poster. My case almost exactly mimics yours. I found it in a google search because I'm trying to find success stories and what might help. I really don't want to have a bone removed. I just wondered if anything has happened since your posting last August? Are you feeling better?

    Thanks in advance for any advice you can provide.
     
  6. Unregistered

    Unregistered Guest

    I to am looking for answers, I was diagnosed with sesamoiditis but unlike most I have read about instead of an overuse injury or impact on the bottom of the foot, I droped something on the top and the concusion downward bruised the sesamoid, the pain was instantly on the bottom not the top. I have had orthodics, cortizone shots, I have been icing and using anti inflamatory meds. It has been very frustrating, I am a runner and triathlete and was suppose to do my first ironman this year but had to back out. I haven't been able to run for almost a year now and it just won't heal. Does anyone have any answers for this, my podiatrist doesn't seem to have any, I don't want to do surgery, then I really wouldn't be able to run.
     
  7. TOG Orthotics

    TOG Orthotics New Member

    What did the podiatrist say, even if it was unhelpful?
     
  8. Unregistered

    Unregistered Guest

    Have you had it checked for a dislocation? This is a common result of smashing injuries or when heavy objects are dropped onto feet. I'm pretty sure it's what I did to my foot when I was about 12.

    After reading Foot Doc's response I will not be using this forum. Completely rude and unnecessary. The original poster is right, how is your response AT ALL helpful? I hope you are not actually a doctor as you seem to be lacking in people skills.
     
  9. Unregistered

    Unregistered Guest

    I had bunion surgery 15 months ago. Bunion looks good and bone is healed. Problem is pain in the ball of my foot sometimes razor like and other times achy. I cannot put pressure on this and am very uncomfortable in shoes. My Dr. has tried everything from injections to creams and I did have 16 sessions of pt. I never had this pain before surgery.
    I went for a second opinion today and this Dr. told me that it is the sesamoids. He showed me where they are located at the bottom of my foot. I have a follow up appt. with another Dr. in this practice who will fit me with a special insert since I do not want surgery that will result in my never wearing heels again.
    My questions are: why didn't my Dr. diagnose this? He has taken many x-rays in his office.
    What is wrong with the sesamoids that I would need corrective measures or surgery? I did not think to ask the Dr. this today but will tomorrow.
    And Could this have been the result of something that happened during the bunion surgery?
     
  10. Unregistered

    Unregistered Guest

    I forgot to mention that the Dr. I saw today suggested that my being thin was related to the pain with the sesamoids. I am not thin and I never had this pain before.
     
  11. Unregistered

    Unregistered Guest

    Hi all - I posted the first reply aside from the original poster saying my problem mimicked the first post in this thread.

    I was told my sesamoid was broken, was in an ortho shoe for 2 weeks, a j-pad for 8 and then was told the MRI showed no break so I was healed. I started physical therapy and was in a lot of pain. Doctor said removal was the next step. After 9 sessions, my PT told me to go to another doctor. First thing she did was x-ray it (this is 5 months after my initial appt with first doctor) and it was STILL broken.

    Now, I've been in a plastic boot (aircast) for 8 weeks and I'm using a bone stimulator (Orthofix). I just had an x-ray tonight and the bridge has been formed. I still wear the boot for another two weeks while the bridge strengthens, but the pain has drastically reduced. I am so thankful I went to another doctor and she actually immobilized me. I think the bone stimulator had a big part in my healing as well.

    I am also a triathlete and might be able to compete later this summer - yay!

    Just wanted to follow up with my story. Good luck to the rest of you!
     
  12. Unregistered

    Unregistered Guest

    I've had sesamoiditis since last September. I went to a podiatrist at the outset, but he didn't know what was wrong. I continued walking and enduring a lot of pain until January of this year, when I saw a sports medicine doctor. At that point it was confirmed that I had sesamoiditis. I've had a lot of swelling that has made it difficult to wear a shoe. My doctor has a blog, drblakeshealingsole.com, that has really great info about sesamoiditis and other problems of the foot. Wearing a dancer's pad has helped to take pressure off the big toe area. I've been walking on the outside of my foot for months. I bought larger, wider running shoes to accommodate the area. Icing a few times a day helps, and I read about someone using a massager for 10 to 20 minutes a few times a day to stimulate the area, which I have done, although sporadically. I've been taking Aleve to take away the incessant pain. I'm down to one Aleve every 3rd day. Taking Aleve isn't helpful for healing the bone, but it has lessened the pain/edema. Its side effects aren't good, and that's why I've been limiting the amount I take.

    The most important thing has been to rest the area completely, as often as possible. This is a very difficult area to heal. I would not be able to run with this condition, nor am I able to walk long distances at this point. My edema is almost gone, but I still experience nagging burning/itching by the big toe.

    I haven't been able to exercise as much as I'd like to because doing so aggravates the area. SLOWLY the area is healing. I have never experienced anything like this before. I used to wonder if I would ever be back to normal, but now I'm thinking that this awful condition is FINALLY subsiding. It's been a LONG haul.

    Check out Dr. Blake's blog. It's been very helpful to me, and a lot of people have written in with their own stories.
     
  13. Unregistered

    Unregistered Guest

    hi ive had the same problem for near on 3 years as well as a bunion. after trying everything i could i have just had surgery to have my bunion done and have part of my sesimoid removed! the doc did not want to remove it and said he would take a look while doing my bunion but found the bone was to damaged and made the decision to ake half of it away.
    I have only had my surgery 5 days ago so early days yet but i do feel that i was so misrible before can it be any worse?
     
  14. Unregistered

    Unregistered Guest

    Hi, I'm the one who posted about Dr. Blake's blog. After having sesamoiditis, and a bone spur on top of it, I'm now using castor oil each day for the sesamoiditis and bone spur. (I forgot to mention the bone spur previously because, as soon as the doc told me I had a bone spur as well as the sesamoiditis, I figured it wasn't of much consequence and focused on the sesamoiditis only. But I've come to realize that it IS a big deal.)

    I use the castor oil from Whole Foods, and I put it on each night, all over both feet. I'm wondering if anyone else could try this and see how they feel after a few weeks. I'm feeling much better, but I'm always wary about any remedy. I've been practicing yoga as well, but I really think the castor oil is doing something.

    If anyone with sesamoiditis or a bone spur has tried castor oil, or is using it now, can you post back here and let me know if it's helped or not? (Maybe I'm living in Dreamland and want it to work so much that I'm imagining the area is improving more than it really is.)

    Thank you!
     
  15. Kajones

    Kajones New Member

    The pain started last April after a repepitive injury at work where I used my right great toe as a lever, I guess, to help turn a patient by myself. Because it didn't hurt too much at first I continued to do this for several days. I also have rheumatoid disease, so of course I blamed the joint pain on that. I was told by my rheumatologist to see a podiatrist, since it was only one joint and it was swollen by not hot. I had steroids injected and missed a month of work, kept my foot up and gained weight 6 pounds. I also realized I would be giving up anything that make this happen again. It healed. It returned in July for a few days following a few days of flip flops and swimming. It healed in 3 days. Oh well, September 10, my toe cramped and the pain returned with a vengeance . I went back to the foot doctor, and long story short our relationship ended with him accusing me of trying to stop working and have him sign off on Social Security disability, the only good thing, his parting remark was you have had sesamoiditis for at least 6 years( my initial foot Xrays for the RA diagnosis). He was a jerk but he was jerk who gave me a diagnosis... I wear MBT shoes and Chung Shi sneakers so I can't hurt the toe but pushing off of it. I also use narcotics, NSAIDs , ice, vibration, and KT tape...which holds my toe DOWN and helps with the spasms and cramps. You can buy it at any sports store, it doesn't tear your skin like regular medical tape does. I've been wearing a pedometer at work, I'm averaging 11,000 steps a night, and am missing out on life...between this and the RA I've given up most things I enjoy. I'm going to try everything I've read tonight...starting with Vick's , but also the toe separators. Still going to work and trying for the positive attitude that really does make everything a little better. Thanks for all ideas!
     
  16. Kajones

    Kajones New Member

    Ps the KT tape has a web site with instructions... And YouTube has doctors showing how to do it step by step . Not only this but planter fascitiis etc...
     
  17. Unregistered

    Unregistered Guest

    After one year suffering with sesamoiditis and getting no relief from a cortisone shot, I took the advice of one thread to the extreme-Crocs with Powerstep Pro inserts. I wore them 24/7 for three months along with gel cushion under my big toe. the cushion is made for Hammer toes, but it protected the inflamed area-under the big toe near the ball of the foot. I am finally pain free but continue to wear crocs as often as possible. I also gave up any shoes that require gripping of the toe-no flip flops.

    I am a 58 year old active exerciser, primarily spinning. I continue to use the arch supports and the toe cushion with my spin shoes and any other shoe they will fit in.

    Hope this helps and I thank everyone for sharing their ideas, this injury sucks!
     
  18. Unregistered

    Unregistered Guest

    I've read many of the posts, and I as well, have seismoiditis. I've had it for 14 years, and only for the last two years, has been very painful. As the first post, I have a fracture in one of my seismoid bones, and have used all the dancer pads, meditarsal pads, and cortisone shots and orthothotics. It's been suggested that I have the surgery to remove the bone, however, I've yet to hear from anyone that the surgery was successful and how long the recovery period truly is. I'm told 6 to 8 weeks, and then several months of rest. Curious to hear if anyone has had the surgery.
     
  19. huss

    huss Guest

    Hello There,
    I hurt my foot last may, its now Feb. I was told in ER that I had a dislocated toe and 2nd toe dislocated too. I finally went to a Podaratrist and was placed in a walking boot. I then was told I was getting charcot from diabetes and might lose these toes. I finally had surgery in october with a Implant i the big toe, and pins inserted in the 2nd and 3rd toe. After one week one pin came out, 3 weeks one pin broke in half and after a month the implant shattered my big toe and all my toes were disformed and I could hardly walk with the pain in the bottom of my foot. I went to a ortho surgeon and had a second opinion. He described the sesmoid bone problems and said i had the wrong hardware in my foot and the worst case of turf toe he ever saw. This time I had surgery a month ago and had a screw in the big toe, pins again in the 2nd toe and a small implant in 2nd toe to stop it from dislocating. I also use the ORTHOFIX bone stimulator for 3 hours everyday. The toes are getting straighter and still have a walking boot on and crutches but the Dr. says the surgery was a huge success and the xrays look great. Removal of the sesmoid bones just takes alot of time to heal and you literally have to just sit home and do nothing. But so far its working..go for my 5 week checkup this week.
     
  20. huss

    huss Guest

    The main part of my post was that I had the sesmoid bones removed and it seemed to be the main problem. I had one taken out the top of the foot and one from the side. DO NOT let them take them out from the bottom, much harder to heal...I can feel a huge diff. already
     
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