Chronic Sesamoiditis - not sure where else to turn.

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. *************************************************** Far be it for me to convince you to have a sesamoidectomy. But if, as I suspect, only one of them is involved and I was absolutely convinced the problem was that sesamoid and I had spent 3 years of failure with conservative care, and symptoms were as dramatically disabling as you assert, surgical removal is precisely the route I would recommend in a patient of my own. I cannot speak to your results, but I have seen very few serious complications in my patients after a sesmoidectomy and I have performed many. Again . . I am not and cannot consult on your specific case, but given a generic case such as you appear to have described, that would be my suggested course of action.

 

Thank you for your response. If you don't mind sharing your experiences, what would the success rate be for a sesamoidectomy? I had an entire list of questions to ask the Surgeon upon my return after the bonescan but he was so against even considering it that I didn't get a chance to ask. I've tried to research it online but am not finding much information either. I will of course ask the surgeon when I see him again on the 14th of January but any help in the meantime would be appreciated, as being a surgeon, he won't really advise on treatment options that don't involve surgery.

He said the main concerns were that the remaining sesamoid would fracture and then need to be removed as well, and that I would develop a bunion or my big toe could end up sticking straight up due to the changes to the tendon once the sesamoid was removed, thus requiring more surgery. He told me in no uncertain terms that there is a great risk I would not get the relief I am searching for from this surgery. I haven't been able to find any information about success rates etc of this surgery online so can only go by what the surgeon has told me. At first visit I was adamant I just wanted the surgery because I am so sick of the pain, but in the subsequent visit after the bonescan I felt like the surgery would only cause further complications.

Besides surgery, is there anything else you could suggest that may help? I was extremely active before it got really bad and I desperately want to return to running etc. Everything online seems to indicate that sesamoiditis can generally be "fixed" without a sesamoidectomy, but I've already tried all the conservative measures (that I know of, anyway).

In your opinion (I know you can't give specific advice, but perhaps just in your experience), if the proper care was taken, rest, orthotics to correct flatfooted-ness and overpronation etc and the problem still wasn't improving, why would that be? Do you think it's possible I still haven't gotten a correct diagnosis, or there is more going on than this?

Thanks again for your time. I know you are limited in what you can tell me but anything would be appreciated.

 

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. *********************************************************.All surgeries and medical treatments pose potential complication. Doctors must weight those complication as related to his/her previous experiences in determining the advisability of any procedure. If a doctor has performed a significant numbers of a certain procedure and has had a high incidence of undesirable results, I would take that very seriously in any decision to have HIM or HER perform the procedure. But that does not necessarily mean that other doctors have had the same experience. In regard to the complications you have indicated, they are indeed possibilities, but in my PERSONAL experience, such has rarely occurred. A sesamoidectomy should not be considered unless one is certain as to the diagnosis and that all reasonable conservative measures have been attempted without significant results. Forums such as this are not appropriate venues for one to make a decision regarding the treatment of a specific individual case. You would be far wiser to obtain an independent second opinion from another well-vetted specialist

 

I suffered from similar problems to you although my pain was in all my sesamoid bones, not just one! But just to give you another person's experience I ended up having all 4 sesamoids removed individually. I did have complications with the big toe sticking up on one foot but only after the 2nd sesamoid bone had been removed; I did not have any problems at all with just one removed and the pain was completely relieved.

As the Foot Doc says I wouldn't say to you that you should have your sesamoid removed but you stated that everything you had read was negative so I'm giving you a positive view! I'm glad I had mine done as it did relieve my pain. I continue to have foot pain issues and still require orthotics but do not believe this is related to the sesamoid removal, my pain is not under the big toe joint.

I have had lots of foot surgery in my life and you are right to be cautious about entering into it but I believe you have to weigh up how much your foot pain is affecting your life. There comes a point when surgery is the right option and can improve things but only you can decide when you reach that point.

I hope things work out for you.

 

When BOTH sesamoids are removed on one foot there is a high likelihood of cock-up toe due to damage to both tendons of the flexor hallucis brevis muscle. That is not generally the case when only one is removed.

 

Thank you very much for your response.

I will seek a second opinion from another Surgeon and review my options from there.

 

Please post back with with the results of your second opinion.

 

I would also be intrigued by your second opinion/follow up.

Reading your post has practically mirrored my own experiences. After 5 years of (fibular) sesamoidititis, prob mild also as I was told today it was a 'boring' kind of sesamoiditits and trying all the same treatments (except the walking cast as they felt it was pointless) the consultant has told me today there are no other treatments worth trying and surgery would be the only option or stay as I am. He also said there was only a 50% chance of success.
Saying that after reading articles, this forum and many other forums I do feel a little more boyant about the prospect of having the surgery but I am definately going to get a second opinion. I am waiting for another MRI scan to be scheduled as my last one was 3 years ago now and then see what is said after that.

Good luck I look forward to seeing your update.

 

I was here on this site a couple of months ago looking for some hope for my sesamoiditis. I hurt my sesamoid bones while foolishly walking/dancing barefoot on a hard floor. (It was too hot to bother with shoes in August.) It didn't even hurt while I was doing that. It was a day or two later when the pain began and it has done nothing but get worse. By late September I had progressed to limping, which sent me to a podiatrist. He told me that if I wanted the sesmoid bones to heal, I would have to stay off them. They were so tender, red, and swollen, I couldn't even touch them, let alone walk on them. It hurt to push the gas pedal to drive and even the weight of the blankets on my bed hurt them at night. I have it in both feet, my right one worse than my left. Well, how do you stay off your feet if you have to work and have a life? He gave me some felt pads to wear under the arches of my feet, and it was a relief to have the pressure off the balls of my feet, but, of course the felt pads hurt my arches. After taking 12-hour Aleve and resting and icing my feet every day after work for 4 weeks with no change in my condition, I went back to the doctor who prescribed oral steroids. I had high hopes, but they didn't do a thing for me, well, except it did help the arthritis in my thumb. After another 2 weeks went by, I went back for the steroid shot in the ball of my foot, which burned like fire. Yeow! Still no results. At the next doctor visit, he was talking about surgery to remove them. Well, I was going to try everything in my power to avoid surgery, so I sucked up all the patience I could muster and took off work (office job, mainly sitting) for 3 weeks, using saved up sick days and vacation days to just sit on my butt all day and let my retired husband wait on me hand and foot. After 3 long weeks, still no change!!! But I know that must have done some good. So I just decided I was going to wait it out; surely by body would heal itself if I could just be patient. I went back to work, moving slowly, doing as little on my feet as possible, letting my husband do the Wal-mart shopping, eating take out food, not doing any housework, not going anywhere, not getting to go Christmas shopping and just doing a lot of reading, watching TV and movies, etc. It was hard not to get depressed. The hubby bought me a cushy bathtub mat to stand on in the shower and fatigue mats to stand on in the kitchen and bathroom. I bought some soft shoe insole pads and cut out the place where my sesamoids rest and started wearing those. It was a relief to switch from wearing the felt pads. The cold weather has helped, since my feet are cold enough that I don't have to ice them. Finally after 3+ months of babying my feet, they are suddenly feeling much better now!! It's January and I'm trying to walk normally with custom orthotics, but now my heel and side of my foot hurt from walking on them for so long. I'm so thrilled that I will get my life back; I am dying to dance and powerwalk again. I will never again take my feet for granted!! So I am back on this site to give hope to anybody who has this condition. It won't be easy, but my doctor was right: you have to REST YOUR FEET and sacrifice. Don't give up hope! Best wishes to ya.

 

I hadn't heard of this condition until yesterday when I was searching on the internet to try and figure out the pain in my foot. I think this is what I have but haven't been to the doctor yet. The pain is now excruitiating and I can't take any more pain killers for fear of overdosing! Hence it's half 3 in the morning and I am on the sofa with my foot raised. I'm at a loss with the pain - never felt anything so bad! Just wanted to know how long this is going to go on for? I'm trying not to walk. My big toe and ball of my foot is swollen. Is there any chance of a quick heal or is this likely to drag on?
Yours in pain...

 

Hello All, it has been a year and I have still not been able to heal my sesamoiditis in the right toe. It is difficult. I wear specially made insoles, I've attended therapy, I ice my foot, I take calcium and Cetyl-M supplements for bone strength and reduction in inflammation, and I hardly walk anywhere. I ride a bicycle to class and back home. I rest my feet and use a stationary bike for exercise. Yet, the pain is still there. I refuse to get cortisone injections and surgery because I have not heard of any success from these methods. I would like to try the boot but I doubt it will help, since I have already greatly reduced standing and walking in my daily life. I do not know what else to do. I hope to get an MRI, perhaps that may show something that x-rays didn't, but other than this, I am just hoping to hear a success story somewhere. Good Luck to you all.

 

Hello, I am sorry to hear about your persistent pain. Are you taking anything for the pain? I think you are right about skipping in the cortisone injections at this point. If they didn't help you much the first two times, they won't help now, and can actually cause damage if over used.

To me it doesn't sound like you have much of a choice but to have the surgery. There was one post that said his was success full, and I have seen many others that were successful as well. If you have that much of a problem with it, at your age, don't you have to get it fixed? I'm sorry, but that is the only way I see it.

I don't have a happy story for you, but it is much different, and for the amount of time I had without pain, the surgery was worth it. Two of my siesmoids were completely broken off, and floating in the bottom of my foot. I had to live with that for six months. I could feel the shards cutting into my soft tissue with every step. I also had a plantar plate rupture that had to be repaired.

My surgery went fine, mechanically. But within a couple of days, my pain got worse, real quickly. I had developed a staff infection from the operating room. That seriously sucked. But, its over now, and for two years, I could walk around decently. But, as the doctor above mentions, the problems start when you take out two. I had a surgery on the opposite leg's knee a few years later. I also had to limp around with that injury for months, and all of the pressure was unfortunately focused on the foot that had been operated on. Now I am in pain again.

Like I said, my situation is different. Yours seems to be the best case scenario. I am not a doctor, and not qualified to give you medical advise; but from my experience, I would do it again. And my experience was worse to begin with. You have the odds in your favor. And you cant live with this problem for possibly eighty years can you? Good luck either way.

 

I had my sesamoid removed 6 weeks ago the pain has gone and its healing well but now I am in pain with the stiffness of the joint as it has been fractured for 2 years and I have been walking on the side of my foot and the last 6 weeks of not walking anywhere have not helped. Not sure what to do to get my big toe moving and pushing off on it and just back to how it was before am weightbearing now but still walking on the side getting frustrated now but the doc did say 6-8 weeks to heal so maby I am rushing it a bit.

 

This is an update to Reply #10. I last posted in January, 2011. Now it's mid-March and guess what! I don't have any more pain in my sesamoids!!! It has taken 6 l-o-n-g months of babying my feet, but I persisted, and finally I can say that I have healed. Once the inflammation calmed down, they started healing more quickly. I am still wearing my custom orthotics for a while longer to make sure that I don't have a setback. I am glad that I did not choose surgery, but every case if different, of course. Just wanted to put in a success story. Hard to find one on these sites.

 

Unfortunately, there is no cure other than don’t do anything high impact with your foot. I have had sesamoditis for 2 years. I have a Bipartitie sesamoid in my left foot. I have tried everything possible recommended to me by teh many doctors I have seen - I have read some people have gone to physios to treat their problem, a complete waste of time they can’t do nothing because it is a pressure related inury – if there is stiffness then they can.

Doctors generally sound like they know what they are talking about and use technical words to sound like they know, but actually they don’t know anything about this condition and they simply need to appear that they do.

The fact of the matter is when you get sesamoiditis you are stuck with it for life and any physical sports are no longer an option - you must stop all high impact physical exercising as it will just make it even worse, so running, dancing all must be stopped. Only walking is acceptable and must simply accept you have this condition and try to best live with it. When you get sesamoiditis it is too late to do anything other than trying to accept you have this unfortunate condition.

With regards to post 15 – trust me the pain will be back. It can come and go. It has happened to me – in the two years I have had it I have been pain free for a couple of month and bang it is back.

 

I have had chronic sesamoiditis for 46 years in both feet!!!! I have been in casts, had rolling bars attached to the soles of my shoes, worn Birkenstocks, had orthotics, used metatarsal pads for 10 years, and now I wear MBT shoes. All attempts at pain relief are combined with ice ( and walking in the snow at -40 degrees) , ibuprofen, rest. The structure of my feet has changed... I suspect nerve damage and extra bone growth because of all the adjustments my foot has had to make. My lower back and knees have worked hard to compensate for the "walking on the side of the foot". What works? The MBT shoes are my best bet right now. My left foot refuses to cooperate all day. ( after all these years I like to think of it as having a life of its own) and my right foot is not as painful. The MBT shoes are the best suggestion I have because the shoe allows the foot to roll over the joint. Stores that sell these shoes are usually willing to let you try them out for a few days. Good luck...

 

Hello,

I am interested in the removal of all 4 of your sesamoids. I had one removed from each foot about 4 years ago and have still been living in daily chronic pain. My doctor doesn't recommend the removal of all 4 sesamoids because of effects it has on the big toe. Did you ever consider any sesamoid implants (if they make such a thing)? What did you do keep you big toe in line with your other toes?

Thanks so much!

 

I got sesamoiditis 10 months ago, over the following couple of months I had the sensation of walking on a lump under the ball of my foot and so was walking a lot on the side of my foot, trying to protect the sesamoid, and I eventually lost about 30-40 degrees range of motion in my big toe, x-ray showed no fracture or any kind of peculiarity really, and doctors just recommended rest and orthotics. At its worst, I could barely put weight on the foot, let alone walk on it, was limping heavily and felt severely handicapped. Rest only seemed to make it worse, weakening and stiffening the tendon.

About 7 months ago I started using a device called Correct Toes, invented by the foot doctor Ray Mcclanahan (his clinic is called Northwest Foot & Ankle). They are essentially toe-spreaders, but designed so that you can easily use them with shoes and while standing and walking, and generally while being active. Concurrent with this I also had to get new shoes that were flat and wide enough to let the toes spread out completely (initially crocs, but more recently vivo barefoot). The basic philosophy behind this device is that most foot problems are caused by the deformities and misalignments our feet gradually develop by wearing normal narrow shoes, and wearing Correct Toes allows you to correctly realign the bones and tendons of your feet and so makes it possible for your body to properly heal the injured structures.

It took my feet a long time to adjust to wearing the Correct Toes, I'm only now capable of wearing them all day long as intended. My sesamoiditis is still not fully healed, but ever since I started wearing them, I have seen slow but steady improvement in my condition. I have no significant pain while standing and walking, have fully restored the range of motion of my big toe, and have even gone out for a few short jogs without problems. What remains is some slight swelling and that my sesamoid still gets achy if I walk around too much, but I think wearing the Correct Toes will allow me to make a full recovery. They have also completely eliminated my even more longstanding problems with achilles tendinosis (4+ years) and knee pain.

 

Large toe spacers to help sesamoiditis

Hello,

I read your entry with interest because I have had sesamoiditis for over a year. At least I think it's sesamoiditis. The x-rays showed no fracture, but the doctor told me I ought to have an MRI and also said that I should be well in 6-1/2 weeks to 2 months. At $500 I decided not to have the MRI. My left foot was so swollen that I could barely wear a shoe for months, and the 2-month period the doctor said came and went and still no improvement. Since I currently am not driving my car and live in a large city, I usually ended up walking, taking a bus, or taking a taxi (expensive). Needless to say, my life was pretty much at a standstill unless I had to go out. Added to everything else was the feeling that I was walking on an open blister all the time on the ball of my foot. I wore a dancer's pad and always walked on the outside of my foot for over 6 months. That helped for awhile, but I developed a knot on the outside of my foot because I wanted to avoid touching the pavement with the ball of my foot. I iced my foot, which helped short-term, and I also took Aleve, only about one per day, which helped tremendously but is very dangerous long-term. I finally got it down to 1/2 every couple of days because I was worried about the awful side effects and forums I read about it on the Internet. When I decided to go off the Aleve, I suffered all night long from intense itching and burning in my foot and into the next day until it pretty much left my system. I'm SO HAPPY that I've weaned myself from Aleve as it really is a nasty drug. But the itching and burning, though not as intense as before, was difficult to take, and the ball of my foot was still very tender.

My sister had told me about toe spacers, and I was only familiar with the smaller ones. After I read your post, I went on the podiatrist site and saw the larger ones. I found some at Walgreens yesterday, 2 to a package for $5.99, and bought those. Right now I only use them for the big toes, but I'm going to go out and buy some more so that I can have them between all my toes. I also got some Keen shoes, with a very wide toe box, and my toes have lots of room. It's kind of hard to believe, but my foot feels so much better today!!!!

This has been a VERY ROUGH year, and I won't ever take my feet for granted again. Initially I think I got sesamoiditis because I was wearing too-small shoes, started a walking regimen with way too much walking outright, and was wearing tight socks. The feet, so very important, deserve proper care, and I've learned a very tough lesson. I never realized that two little bones could cause so much pain.

THANK YOU for your post!!!! I think the large toe spacers are helping me a great deal. I also bought something called Icy Hot Naturals for $1.99 at Walgreens, and it has helped as well, but certainly not as much as the large toe spacers! Today I actually feel as if the area will heal!!! For a long while I've wondered if I would ever be able to walk with ease again. Right now I don't want to wake up from the dream and realize that I'm back at square 1!!! It's only my second day of wearing the toe spacers, but I really hope they continue to help improve both feet, as I know my right foot was compromised as well from the poor alignment I had when walking on the outside of my foot!!!